Healthcare Provider Details

I. General information

NPI: 1427890250
Provider Name (Legal Business Name): RED APPLE MEDICINE P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4503 KISSENA BLVD FL 1
FLUSHING NY
11355-3429
US

IV. Provider business mailing address

4 LAKE RD W
GREAT NECK NY
11020-1616
US

V. Phone/Fax

Practice location:
  • Phone: 646-801-0701
  • Fax:
Mailing address:
  • Phone: 646-573-0943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. VIVIEN LIM
Title or Position: OWNER
Credential: MD
Phone: 646-801-0701