Healthcare Provider Details

I. General information

NPI: 1649569559
Provider Name (Legal Business Name): QUN LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 OPAL ST
HOLBROOK NY
11741-4709
US

IV. Provider business mailing address

3 OPAL ST
HOLBROOK NY
11741-4709
US

V. Phone/Fax

Practice location:
  • Phone: 631-563-2818
  • Fax:
Mailing address:
  • Phone: 631-563-2818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number001725
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: