Provider Demographics
NPI:1114902723
Name:LIM, JESSICA W (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:W
Last Name:LIM
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Gender:F
Credentials:MD
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Mailing Address - Street 1:186 E 76TH ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2844
Mailing Address - Country:US
Mailing Address - Phone:212-434-2323
Mailing Address - Fax:212-434-2323
Practice Address - Street 1:186 E 76TH ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2844
Practice Address - Country:US
Practice Address - Phone:212-434-2323
Practice Address - Fax:212-434-6885
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2007-12-21
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Provider Licenses
StateLicense IDTaxonomies
NY192554-1207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01859787Medicaid
NYG73326Medicare UPIN
NY01859787Medicaid