Healthcare Provider Details

I. General information

NPI: 1740690957
Provider Name (Legal Business Name): MENGFEI LIU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 TEMPLE ST STE 1A
NEW HAVEN CT
06510-2715
US

IV. Provider business mailing address

40 TEMPLE ST STE 1A
NEW HAVEN CT
06510-2715
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4138
  • Fax: 203-737-1345
Mailing address:
  • Phone: 203-785-4138
  • Fax: 203-737-1345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number62053
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number72956
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: