Provider Demographics
NPI:1033358353
Name:LIM, ANTHONY TAN (PT)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:TAN
Last Name:LIM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 DAVENPORT AVE
Mailing Address - Street 2:APT. BSMT
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-3626
Mailing Address - Country:US
Mailing Address - Phone:914-355-4864
Mailing Address - Fax:
Practice Address - Street 1:50 DAVENPORT AVE
Practice Address - Street 2:APT. BSMT
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10805-3626
Practice Address - Country:US
Practice Address - Phone:914-355-4864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0252892251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics