MEDICARE: JENNIFER LIU MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	25MA077594	NJ
2	2084P0804X	Child & Adolescent Psychiatry Physician	218829	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184707812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LIU MD

Provider Business Mailing Address
First Line	:	39 SPRING VALLEY RD
Second Line	:
City	:	MONTVALE
State	:	NJ
Zip	:	07645-1702
Country	:	US
Telephone Number	:	646-285-3150
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 GUSTAVE L LEVY PL # 1228
Second Line	:	MOUNT SINAI HOSPITAL
City	:	NEW YORK
State	:	NY
Zip	:	10029-6574
Country	:	US
Telephone Number	:	212-241-6798
Fax Number	:	212-241-9311

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	04/20/2012

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Directions to “ JENNIFER LIU MD” Practice Location

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