Healthcare Provider Details

I. General information

NPI: 1487817334
Provider Name (Legal Business Name): BILLY YUANBIAO LIU PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1787 W 4TH ST
BROOKLYN NY
11223-1504
US

IV. Provider business mailing address

1787 W 4TH ST
BROOKLYN NY
11223-1504
US

V. Phone/Fax

Practice location:
  • Phone: 212-274-1705
  • Fax: 212-274-0776
Mailing address:
  • Phone: 212-274-1705
  • Fax: 212-274-0776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number7167
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: