Healthcare Provider Details

I. General information

NPI: 1437653672
Provider Name (Legal Business Name): HONGDAU PETER LIU MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PETER HONGDAU LIU

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 BLONDELL AVE
BRONX NY
10461-2660
US

IV. Provider business mailing address

1575 BLONDELL AVE
BRONX NY
10461-2660
US

V. Phone/Fax

Practice location:
  • Phone: 718-862-8840
  • Fax:
Mailing address:
  • Phone: 718-862-8840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number336999
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number336999
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: