1023206612 NPI number — JOSEPHINE MYUNGHI RIM M.D.

Table of content: JOSEPHINE MYUNGHI RIM M.D. (NPI 1023206612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023206612 NPI number — JOSEPHINE MYUNGHI RIM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIM
Provider First Name:
JOSEPHINE
Provider Middle Name:
MYUNGHI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023206612
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21 DORA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLMDEL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07733-1624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-655-5642
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 HAZLET AVE
Provider Second Line Business Practice Location Address:
SUITE 12
Provider Business Practice Location Address City Name:
HAZLET
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07730-1623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-379-7773
Provider Business Practice Location Address Fax Number:
732-264-6889
Provider Enumeration Date:
10/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  208985 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P2900X , with the licence number: 25MA07842200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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