Provider Demographics
NPI:1568516896
Name:LIM, JOCELYN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOCELYN
Middle Name:MARIE
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 1:187 BROWERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WEST PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2609
Mailing Address - Country:US
Mailing Address - Phone:973-812-0618
Mailing Address - Fax:
Practice Address - Street 1:187 BROWERTOWN RD
Practice Address - Street 2:
Practice Address - City:WEST PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07424-2609
Practice Address - Country:US
Practice Address - Phone:973-812-0618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53027207R00000X
NY211997207R00000X
NJ25MA08087700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C530271OtherMEDICARE PIN
NJ0241512Medicaid
CA00C530270OtherMEDICARE PIN
NY01891881Medicaid
NY01891881Medicaid
CA00C530270OtherMEDICARE PIN
NJ0241512Medicaid