Provider Demographics
NPI:1417103698
Name:LIM, RONALDO A (PT)
Entity Type:Individual
Prefix:
First Name:RONALDO
Middle Name:A
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 1:100 HAMILTON PLZ
Mailing Address - Street 2:3RD FLR
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07505-2109
Mailing Address - Country:US
Mailing Address - Phone:973-279-2323
Mailing Address - Fax:973-279-7551
Practice Address - Street 1:100 HAMILTON PLZ
Practice Address - Street 2:3RD FLR
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-2109
Practice Address - Country:US
Practice Address - Phone:973-279-2323
Practice Address - Fax:973-279-7551
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00868500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist