Healthcare Provider Details

I. General information

NPI: 1376855007
Provider Name (Legal Business Name): HENNY LIWAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2010
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 POTTER BLVD
BRIGHTWATERS NY
11718
US

IV. Provider business mailing address

404 POTTER BLVD
BRIGHTWATERS NY
11718-1830
US

V. Phone/Fax

Practice location:
  • Phone: 631-376-0055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2020-00262
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301096524
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: