Healthcare Provider Details

I. General information

NPI: 1154437267
Provider Name (Legal Business Name): REN Y LIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

846 BROADWAY
BAYONNE NJ
07002-3080
US

IV. Provider business mailing address

846 BROADWAY P. O. BOX 79
BAYONNE NJ
07002-3080
US

V. Phone/Fax

Practice location:
  • Phone: 201-339-1700
  • Fax:
Mailing address:
  • Phone: 201-339-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA08030800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: