Healthcare Provider Details

I. General information

NPI: 1104597160
Provider Name (Legal Business Name): XIANGYU LIU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5804 MAIN ST
FLUSHING NY
11355-5317
US

IV. Provider business mailing address

14425 75TH AVE
FLUSHING NY
11367-2414
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-1185
  • Fax:
Mailing address:
  • Phone: 347-399-0968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number310289
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: