Healthcare Provider Details

I. General information

NPI: 1730744145
Provider Name (Legal Business Name): YITAO LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 6TH ST
BROOKLYN NY
11215-3609
US

IV. Provider business mailing address

506 6TH ST
BROOKLYN NY
11215-3609
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-3279
  • Fax:
Mailing address:
  • Phone: 718-780-3279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberP1113444
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: