Healthcare Provider Details

I. General information

NPI: 1821848078
Provider Name (Legal Business Name): MR. TIANYU LIU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 03/22/2024
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 CLINTON AVE
BROOKLYN NY
11238-6589
US

IV. Provider business mailing address

800 HARBOR BLVD APT 1407C
WEEHAWKEN NJ
07086-7731
US

V. Phone/Fax

Practice location:
  • Phone: 718-704-1986
  • Fax:
Mailing address:
  • Phone: 646-288-5235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number014439
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: