Healthcare Provider Details

I. General information

NPI: 1578764098
Provider Name (Legal Business Name): LING LIU NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 LYONS AVE CTSURGERY SUITE G5
NEWARK NJ
07112-2027
US

IV. Provider business mailing address

24 SYCAMORE WAY
WARREN NJ
07059-5674
US

V. Phone/Fax

Practice location:
  • Phone: 973-926-6938
  • Fax:
Mailing address:
  • Phone: 908-754-1057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00013200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: