Healthcare Provider Details

I. General information

NPI: 1215602891
Provider Name (Legal Business Name): EMILY LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2021
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 86TH ST
BROOKLYN NY
11209-5002
US

IV. Provider business mailing address

2037 76TH ST
BROOKLYN NY
11214-1305
US

V. Phone/Fax

Practice location:
  • Phone: 917-310-5375
  • Fax:
Mailing address:
  • Phone: 646-571-9536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF346996-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: