Provider Demographics
NPI:1861593873
Name:SIAZON-LEVISTE, CATHERINE LIM (MD)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:LIM
Last Name:SIAZON-LEVISTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:CATHERINE
Other - Middle Name:LIM
Other - Last Name:SIAZON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:29 DAHLGREN PLACE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228
Mailing Address - Country:US
Mailing Address - Phone:718-921-4393
Mailing Address - Fax:
Practice Address - Street 1:1000 SILVER STREET
Practice Address - Street 2:CONNECTICUT VALLEY HOSPITAL
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-7023
Practice Address - Country:US
Practice Address - Phone:860-262-5868
Practice Address - Fax:860-262-5850
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180603208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0251J1Medicare ID - Type Unspecified
00G881Medicare UPIN