Healthcare Provider Details

I. General information

NPI: 1285174094
Provider Name (Legal Business Name): DABO LIU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 04/05/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131-72 40TH ROAD
FLUSHING NY
11354
US

IV. Provider business mailing address

125 WALKER ST
NEW YORK NY
10013-4135
US

V. Phone/Fax

Practice location:
  • Phone: 718-587-1111
  • 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 Code207R00000X
TaxonomyInternal Medicine Physician
License Number306258
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: