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General NPI Number Information
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NPI Number | 1316974306
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Entity Type | Individual
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Provider Name | TELLY LIM DEMESA M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | CUMBERLAND DIAGNOSTIC & TREATMENT CENTER 100 NORTH PORTLAND AVENUE
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City | BROOKLYN
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State | NY
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Zip | 11205
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Country | US
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Telephone | 718-260-7895
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Fax | 718-260-7636
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Provider Business Mailing Address
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Address Line | 34 CROAK AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10314-5638
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Country | US
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Telephone | 718-260-7759
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Fax | 718-983-1840
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 150826
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License Number State | NY
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