Provider Demographics
NPI:1487785721
Name:LIM, HEIDI DIANE (PA-C)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:DIANE
Last Name:LIM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 WEBSTER AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1361
Mailing Address - Country:US
Mailing Address - Phone:845-454-0120
Mailing Address - Fax:845-454-6080
Practice Address - Street 1:1 WEBSTER AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1361
Practice Address - Country:US
Practice Address - Phone:845-454-0120
Practice Address - Fax:845-454-6080
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2009-02-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY013141363A00000X
AK515363A00000X
AZ2369363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant