Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | X011650-1 | NY |
N | 111NN1001X | Nutrition | X011650-1 | NY |
NPI | 1235308172 |
---|---|
Provider Name | Dr. Sophia Vivian Lin |
First Address | Rocky Point, NY 11778-8875 |
Second Address | Port Jefferson Station, NY 11776-2245 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2008 |
Last Update Date | 18/02/2009 |