Healthcare Provider Details

I. General information

NPI: 1417103698
Provider Name (Legal Business Name): RONALDO A LIM PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HAMILTON PLZ 3RD FLR
PATERSON NJ
07505-2109
US

IV. Provider business mailing address

100 HAMILTON PLZ 3RD FLR
PATERSON NJ
07505-2109
US

V. Phone/Fax

Practice location:
  • Phone: 973-279-2323
  • Fax: 973-279-7551
Mailing address:
  • Phone: 973-279-2323
  • Fax: 973-279-7551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00868500
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: