Healthcare Provider Details

I. General information

NPI: 1205927191
Provider Name (Legal Business Name): MING-KONG LIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N WASHINGTON AVE
BERGENFIELD NJ
07621-1742
US

IV. Provider business mailing address

8 CARR PL
CLOSTER NJ
07624-1011
US

V. Phone/Fax

Practice location:
  • Phone: 201-501-0082
  • Fax: 201-501-8859
Mailing address:
  • Phone: 201-767-8158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA06483400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MA06483400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: