Provider Demographics
NPI:1518390665
Name:LIM, GILBERT B (MS ED)
Entity Type:Individual
Prefix:MR
First Name:GILBERT
Middle Name:B
Last Name:LIM
Suffix:
Gender:M
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 MCALESTER AVE
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-3719
Mailing Address - Country:US
Mailing Address - Phone:646-266-1804
Mailing Address - Fax:516-465-0391
Practice Address - Street 1:45 MCALESTER AVE
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3719
Practice Address - Country:US
Practice Address - Phone:646-266-1804
Practice Address - Fax:516-465-0391
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist