Healthcare Provider Details

I. General information

NPI: 1568173094
Provider Name (Legal Business Name): MIN LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24411 73RD AVE
LITTLE NECK NY
11362-2321
US

IV. Provider business mailing address

24411 73RD AVE
LITTLE NECK NY
11362-2321
US

V. Phone/Fax

Practice location:
  • Phone: 917-213-2533
  • Fax:
Mailing address:
  • Phone: 917-213-2533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number003730
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: