MEDICARE: MI JIN LIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	341149	NY

General Provider Information

NPI Number	:	1861925190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MI JIN LIM

Provider Business Mailing Address
First Line	:	230 E 75TH ST
Second Line	:	APT 3A
City	:	NEW YORK
State	:	NY
Zip	:	10021-2914
Country	:	US
Telephone Number	:	646-875-0784
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 E 75TH ST
Second Line	:	APT 3A
City	:	NEW YORK
State	:	NY
Zip	:	10021-2914
Country	:	US
Telephone Number	:	646-875-0784
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2017
Last Update Date	:	04/04/2017

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