Healthcare Provider Details

I. General information

NPI: 1225061054
Provider Name (Legal Business Name): ANDREW K LIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 09/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 W SHERMAN AVE
VINELAND NJ
08360-6912
US

IV. Provider business mailing address

1505 W SHERMAN AVE
VINELAND NJ
08360-6912
US

V. Phone/Fax

Practice location:
  • Phone: 856-641-7940
  • Fax: 856-641-7657
Mailing address:
  • Phone: 856-641-7937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number25MA08090700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: