Healthcare Provider Details

I. General information

NPI: 1689290306
Provider Name (Legal Business Name): AURELIA BAOZHU LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2020
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2083 HENDRICKSON ST
BROOKLYN NY
11234-5038
US

IV. Provider business mailing address

2083 HENDRICKSON ST
BROOKLYN NY
11234-5038
US

V. Phone/Fax

Practice location:
  • Phone: 917-328-0178
  • Fax:
Mailing address:
  • Phone: 917-328-0178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number725324
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: