Basic Information
| Provider Information | |||||||||
| NPI: | 1902894090 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HILL | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | J | ||||||||
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| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 665 SARATOGA RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | GANSEVOORT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128311599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5183638815 | ||||||||
| FaxNumber: | 5183638831 | ||||||||
| Practice Location | |||||||||
| Address1: | 665 SARATOGA RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | GANSEVOORT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128311599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5183638815 | ||||||||
| FaxNumber: | 5183638831 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2005 | ||||||||
| LastUpdateDate: | 05/02/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 232717 | MA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 032-0064779 | VT | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 237029 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02694397 | 05 | NY | MEDICAID | 2141957 | 05 | MA | MEDICAID | 1011966 | 05 | VT | MEDICAID |