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General NPI Number Information
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NPI Number | 1013083088
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Entity Type | Individual
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Provider Name | LAURENCE LIM DPT, OCS, CRED.MDT
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Gender | Male
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 25 PROSPECT AVE
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City | HACKENSACK
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State | NJ
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Zip | 07601-1960
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Country | US
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Telephone | 201-342-1404
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Fax |
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Provider Business Mailing Address
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Address Line | 220 CURLEY CT
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City | PARAMUS
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State | NJ
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Zip | 07652-1632
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 40QA00721200
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License Number State | NJ
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