Provider Demographics
NPI:1467582080
Name:LIM, LOLITA (MD)
Entity Type:Individual
Prefix:DR
First Name:LOLITA
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LOLITA
Other - Middle Name:D,
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11 WILCOX AVE. YONKERS NY 10705-2722
Mailing Address - Street 2:175 MEMORIAL HIGHWAY,STE-LL-11,NEW ROCHELLE NY 10
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10802
Mailing Address - Country:US
Mailing Address - Phone:914-968-4227
Mailing Address - Fax:914-457-4699
Practice Address - Street 1:175 MEMORIAL HIGHWAY STELL11
Practice Address - Street 2:
Practice Address - City:NEW RROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801
Practice Address - Country:US
Practice Address - Phone:914-633-3125
Practice Address - Fax:914-633-7213
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00145477208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00705793Medicaid
NY083A921 LLMedicare ID - Type Unspecified
NY00705793Medicaid