Healthcare Provider Details

I. General information

NPI: 1578054508
Provider Name (Legal Business Name): WEN LIU MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2018
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 JAMES ST STE A12G3A3D
MORRISTOWN NJ
07960-6392
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 973-539-0333
  • Fax: 973-538-6111
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number25MA11698000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: