Provider Demographics
NPI:1801053087
Name:VICENTE D LIM PA
Entity type:Organization
Organization Name:VICENTE D LIM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:973-226-5780
Mailing Address - Street 1:3 HAMILTON DR EAST
Mailing Address - Street 2:
Mailing Address - City:NORTH CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-4602
Mailing Address - Country:US
Mailing Address - Phone:973-226-5779
Mailing Address - Fax:973-226-2306
Practice Address - Street 1:1039 AVENUE C
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-3217
Practice Address - Country:US
Practice Address - Phone:201-437-9955
Practice Address - Fax:201-437-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MAO2714800208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ500117Medicare PIN