Provider Demographics
NPI:1558370775
Name:LIM, ESTER G (MD)
Entity Type:Individual
Prefix:
First Name:ESTER
Middle Name:G
Last Name:LIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SNOWDANCE LN
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1565
Mailing Address - Country:US
Mailing Address - Phone:631-360-1587
Mailing Address - Fax:
Practice Address - Street 1:550 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:SHIRLY
Practice Address - State:NY
Practice Address - Zip Code:11967
Practice Address - Country:US
Practice Address - Phone:631-852-1001
Practice Address - Fax:631-852-1122
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133532208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01769873Medicaid
C10072Medicare UPIN
NY01769873Medicaid