Healthcare Provider Details

I. General information

NPI: 1215036371
Provider Name (Legal Business Name): YAN LIU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 MITCHELL AVE
BINGHAMTON NY
13903-0000
US

IV. Provider business mailing address

40 MITCHELL AVE
BINGHAMTON NY
13903-0000
US

V. Phone/Fax

Practice location:
  • Phone: 607-723-1676
  • Fax: 607-772-6304
Mailing address:
  • Phone: 607-723-1676
  • Fax: 607-772-6304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number239253
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: