Healthcare Provider Details

I. General information

NPI: 1669558870
Provider Name (Legal Business Name): JASON SHIXIE LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3370 PRINCE ST STE 104
FLUSHING NY
11354-2745
US

IV. Provider business mailing address

3370 PRINCE ST STE 104
FLUSHING NY
11354-2745
US

V. Phone/Fax

Practice location:
  • Phone: 718-359-5603
  • Fax: 718-359-5610
Mailing address:
  • Phone: 917-579-0310
  • Fax: 718-359-5610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number216399
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: