Basic Information
Provider Information
NPI: 1851372429
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LIM
FirstName: SABINA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 184 LIBERTY ST
Address2: LV-117
City: NEW HAVEN
State: CT
PostalCode: 065191625
CountryCode: US
TelephoneNumber: 2036882619
FaxNumber: 2037372221
Practice Location
Address1: 184 LIBERTY ST
Address2: LV-117
City: NEW HAVEN
State: CT
PostalCode: 065191625
CountryCode: US
TelephoneNumber: 2036882619
FaxNumber: 2037372221
Other Information
ProviderEnumerationDate: 11/09/2005
LastUpdateDate: 03/11/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800X041705CTY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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