Healthcare Provider Details

I. General information

NPI: 1679069108
Provider Name (Legal Business Name): XING LIU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4142 24TH ST APT 519
LONG ISLAND CITY NY
11101-3977
US

IV. Provider business mailing address

4142 24TH ST APT 519
LONG ISLAND CITY NY
11101-3977
US

V. Phone/Fax

Practice location:
  • Phone: 706-254-6310
  • Fax:
Mailing address:
  • Phone: 706-254-6310
  • Fax: 706-254-6310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number093452
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: