Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 22DI02820400 | NJ |
Y | 213EG0000X | General Practice | 22DI02820400 | NJ |
NPI | 1003463431 |
---|---|
Provider Name | Dr. Ricky Lim |
First Address | Hammonton, NJ 08037-1875 |
Second Address | Hammonton, NJ 08037-2018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2019 |
Last Update Date | 04/05/2021 |