Healthcare Provider Details

I. General information

NPI: 1639996424
Provider Name (Legal Business Name): GABRIELLA LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 S FRANKLIN AVE
BERGENFIELD NJ
07621-2015
US

IV. Provider business mailing address

67 S FRANKLIN AVE
BERGENFIELD NJ
07621-2015
US

V. Phone/Fax

Practice location:
  • Phone: 973-471-3046
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR01202300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: