Healthcare Provider Details

I. General information

NPI: 1518659473
Provider Name (Legal Business Name): ALEXANDER J LIU EI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 05/22/2023
Certification Date: 05/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2182 59TH ST APT 1
BROOKLYN NY
11204-2529
US

IV. Provider business mailing address

2182 59TH ST APT 1
BROOKLYN NY
11204-2529
US

V. Phone/Fax

Practice location:
  • Phone: 631-830-2336
  • Fax:
Mailing address:
  • Phone: 631-830-2336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2784579
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: