Provider Demographics
NPI:1093321663
Name:LIM, BYUNG SUK (APN)
Entity Type:Individual
Prefix:
First Name:BYUNG SUK
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 ENGLISH CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-2339
Mailing Address - Country:US
Mailing Address - Phone:908-456-3534
Mailing Address - Fax:
Practice Address - Street 1:2 LINCOLN HWY STE 301
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3904
Practice Address - Country:US
Practice Address - Phone:732-549-7380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01055500363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NJ01055500OtherNJ BOARD OF NURSING