Basic Information
| Provider Information | |||||||||
| NPI: | 1679839922 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIMJUCO | ||||||||
| FirstName: | ALEXANDER | ||||||||
| MiddleName: | PHILIP | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3445 HIGH POINT BLVD STE 400 | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180177817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108665555 | ||||||||
| FaxNumber: | 6108663151 | ||||||||
| Practice Location | |||||||||
| Address1: | 3445 HIGH POINT BLVD STE 400 | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180177817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108665555 | ||||||||
| FaxNumber: | 6108663151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2012 | ||||||||
| LastUpdateDate: | 06/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | ME130957 | FL | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 25MA10412000 | NJ | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 26057 | WV | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | MD465205 | PA | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.