Provider Demographics
NPI:1801042478
Name:LIM, SUET Y (OTR)
Entity Type:Individual
Prefix:
First Name:SUET
Middle Name:Y
Last Name:LIM
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1259 ROUTE 46
Mailing Address - Street 2:BUILDING #3
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-4909
Mailing Address - Country:US
Mailing Address - Phone:973-334-4321
Mailing Address - Fax:973-334-1095
Practice Address - Street 1:405 NORTHFIELD AVE
Practice Address - Street 2:SUITE #LL1
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-3026
Practice Address - Country:US
Practice Address - Phone:973-731-1950
Practice Address - Fax:973-731-1242
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00472400225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ178283NXZMedicare PIN