Healthcare Provider Details

I. General information

NPI: 1710627609
Provider Name (Legal Business Name): STEPHANIE LIU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 FROM RD FL 5
PARAMUS NJ
07652-3517
US

IV. Provider business mailing address

789 WOODLAND AVE
ORADELL NJ
07649-1431
US

V. Phone/Fax

Practice location:
  • Phone: 201-639-6630
  • Fax: 201-639-6631
Mailing address:
  • Phone: 305-338-8238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA12840400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: