Healthcare Provider Details

I. General information

NPI: 1861707085
Provider Name (Legal Business Name): QIUSHUANG LIU O.M.D, L. AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3857 KINGS HWY APT 1J
BROOKLYN NY
11234-2943
US

IV. Provider business mailing address

6636 YELLOWSTONE BLVD APT 9H
FOREST HILLS NY
11375-2510
US

V. Phone/Fax

Practice location:
  • Phone: 718-513-6921
  • Fax: 718-513-6923
Mailing address:
  • Phone: 917-535-3654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number001136-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: