Healthcare Provider Details

I. General information

NPI: 1982957783
Provider Name (Legal Business Name): MR. MINGYU LIU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19233 UNDERHILL AVE
FRESH MEADOWS NY
11365
US

IV. Provider business mailing address

19233 UNDERHILL AVE
FRESH MEADOWS NY
11365-2332
US

V. Phone/Fax

Practice location:
  • Phone: 718-790-1730
  • Fax:
Mailing address:
  • Phone: 718-790-1730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number002518
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: