MEDICARE: JENNY LIU MD, MS

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	207R00000X	Internal Medicine Physician	MA07506100	NJ
2	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1720016108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY LIU MD, MS

Provider Business Mailing Address
First Line	:	190 STATE ROUTE 18 STE 202
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-1407
Country	:	US
Telephone Number	:	732-828-9988
Fax Number	:	732-828-1010

Provider Business Practice Location Address
First Line	:	190 STATE ROUTE 18 STE 202
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-1407
Country	:	US
Telephone Number	:	732-828-9988
Fax Number	:	732-828-1010

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	03/16/2023

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