Healthcare Provider Details

I. General information

NPI: 1104271469
Provider Name (Legal Business Name): GASTON MIKE LIU DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2016
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 VETERANS MEMORIAL HWY STE 9
COMMACK NY
11725-4351
US

IV. Provider business mailing address

57 SOUTHERN BLVD STE 1
NESCONSET NY
11767-1091
US

V. Phone/Fax

Practice location:
  • Phone: 631-836-6651
  • Fax: 631-883-6636
Mailing address:
  • Phone: 631-634-5448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN007083
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN007083-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: