Provider Demographics
NPI:1780342238
Name:LIMA, NIKO VINSON CADUNGOG (PT)
Entity type:Individual
Prefix:MR
First Name:NIKO VINSON
Middle Name:CADUNGOG
Last Name:LIMA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2415
Mailing Address - Country:US
Mailing Address - Phone:160-738-6588
Mailing Address - Fax:
Practice Address - Street 1:5392 STATE HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-3419
Practice Address - Country:US
Practice Address - Phone:607-386-5889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039224225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist