Individual provider Active NPI

Angenis Lin, PA-C

  • Medical Physician Assistant
  • Brooklyn, NY
National Provider Identifier
1710517305
Registry record updated Apr 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
024519-01 Issued in NY
Practice address
585 Schenectady Ave
Brooklyn, NY 11203-1822
Phone
(718) 604-5000
NPI assigned
Jan 22, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 024519-01 NY Primary

Addresses

Primary practice location

585 Schenectady Ave
Brooklyn, NY 11203-1822

Mailing address

585 Schenectady Ave
Brooklyn, NY 11203-1822
Phone (718) 604-5000

Other practice location 1

1526 83rd St
Brooklyn, NY 11228-3130
Phone (718) 313-6106

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200622001331 NY Practitioner - Physician Assistant 1254753288 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
024519NYMDOccupational Therapist
024519-01NYMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
New York Community Hospital of Brooklyn Inc CurrentSince Aug 20, 2022 Accepting new patients
Kingsbrook Medical Associates PC CurrentSince May 15, 2020 Accepting new patients

Locations

585 Schenectady Ave
Brooklyn, NY 11203
Phone (718) 604-0461

2525 Kings Hwy
Brooklyn, NY 11229
Phone (718) 692-5300

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1579651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618876800000",
    "number": "1710517305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "585 SCHENECTADY AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112031822",
            "telephone_number": "718-604-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "585 SCHENECTADY AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112031822",
            "telephone_number": "718-604-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1526 83rd St",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112283130",
            "country_code": "US",
            "telephone_number": "718-313-6106",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIN",
        "first_name": "ANGENIS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-22",
        "last_updated": "2021-04-20",
        "certification_date": "2021-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "024519-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.