Provider Demographics
NPI:1487003448
Name:CHAN, LAWRENCE ANDREW LIM (DO)
Entity type:Individual
Prefix:
First Name:LAWRENCE ANDREW
Middle Name:LIM
Last Name:CHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 CLARKSON AVE # 30
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2012
Mailing Address - Country:US
Mailing Address - Phone:718-270-2055
Mailing Address - Fax:718-270-3440
Practice Address - Street 1:450 CLARKSON AVE # 30
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2012
Practice Address - Country:US
Practice Address - Phone:718-613-8653
Practice Address - Fax:718-270-3440
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319265208100000X
NJ25MB11467300208100000X
PAOT017231207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine