Healthcare Provider Details

I. General information

NPI: 1164103255
Provider Name (Legal Business Name): COURTNEY SHUIYING LIANG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13172 40TH RD
FLUSHING NY
11354-5137
US

IV. Provider business mailing address

125 WALKER ST
NEW YORK NY
10013-4135
US

V. Phone/Fax

Practice location:
  • Phone: 718-886-1287
  • Fax: 718-886-3903
Mailing address:
  • Phone: 212-226-8866
  • Fax: 212-226-2289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number009902
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: