Healthcare Provider Details

I. General information

NPI: 1578007753
Provider Name (Legal Business Name): DAVID LIAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE STE 613
HACKENSACK NJ
07601-1962
US

IV. Provider business mailing address

20 PROSPECT AVE STE 613&909
HACKENSACK NJ
07601-1997
US

V. Phone/Fax

Practice location:
  • Phone: 201-489-6520
  • Fax: 201-449-3567
Mailing address:
  • Phone: 201-489-6520
  • Fax: 201-449-3567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number25MA12597800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: