Healthcare Provider Details

I. General information

NPI: 1871212977
Provider Name (Legal Business Name): CHAO LIU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 SCHENCK AVE APT 3G
GREAT NECK NY
11021-3602
US

IV. Provider business mailing address

9 SCHENCK AVE APT 3G
GREAT NECK NY
11021-3602
US

V. Phone/Fax

Practice location:
  • Phone: 973-641-7934
  • Fax:
Mailing address:
  • Phone: 973-641-7934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number4180
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: