Healthcare Provider Details

I. General information

NPI: 1245125632
Provider Name (Legal Business Name): EMILY LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 HAMBLETONIAN WAY
CAMILLUS NY
13031-8640
US

IV. Provider business mailing address

210 UNION AVE APT 2
SYRACUSE NY
13203-1746
US

V. Phone/Fax

Practice location:
  • Phone: 315-227-2555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1658688221
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: