Healthcare Provider Details

I. General information

NPI: 1215032768
Provider Name (Legal Business Name): EDMUND S. LIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: EDMUND S. LIU, MD, PA MD

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 03/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 POMPTON AVE
VERONA NJ
07044-3018
US

IV. Provider business mailing address

207 POMPTON AVE
VERONA NJ
07044-3018
US

V. Phone/Fax

Practice location:
  • Phone: 973-571-1933
  • Fax: 973-571-1904
Mailing address:
  • Phone: 973-571-1933
  • Fax: 973-571-1904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number25MA07394800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: