Healthcare Provider Details

I. General information

NPI: 1083349450
Provider Name (Legal Business Name): KEVIN LIU NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MIDDLE RD
HENRIETTA NY
14467-9312
US

IV. Provider business mailing address

50 MIDDLE RD
HENRIETTA NY
14467-9312
US

V. Phone/Fax

Practice location:
  • Phone: 585-321-4350
  • Fax:
Mailing address:
  • Phone: 585-321-4350
  • Fax: 585-321-4389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number349854
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: