Healthcare Provider Details

I. General information

NPI: 1376385781
Provider Name (Legal Business Name): YU XU LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9114 MERRICK BLVD FL 6
JAMAICA NY
11432-5363
US

IV. Provider business mailing address

9114 MERRICK BLVD FL 6
JAMAICA NY
11432-5363
US

V. Phone/Fax

Practice location:
  • Phone: 718-674-6066
  • Fax:
Mailing address:
  • Phone: 718-674-6066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: