Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 286764 | NY |
Y | 207QS0010X | Family Doctor - Sports Medicine | 286764 | NY |
NPI | 1063825792 |
---|---|
Provider Name | Sangjin Lim |
First Address | Middletown, NY 10941-4057 |
Second Address | Middletown, NY 10941-4057 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2014 |
Last Update Date | 06/08/2021 |