Healthcare Provider Details

I. General information

NPI: 1023206612
Provider Name (Legal Business Name): JOSEPHINE MYUNGHI RIM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 06/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 HAZLET AVE SUITE 12
HAZLET NJ
07730-1623
US

IV. Provider business mailing address

21 DORA LN
HOLMDEL NJ
07733-1624
US

V. Phone/Fax

Practice location:
  • Phone: 732-379-7773
  • Fax: 732-264-6889
Mailing address:
  • Phone: 201-655-5642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number208985
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number25MA07842200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: