Healthcare Provider Details

I. General information

NPI: 1629963533
Provider Name (Legal Business Name): TING LIU
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 QUEENS PLZ N
LONG ISLAND CITY NY
11101-4172
US

IV. Provider business mailing address

2020 126TH ST
COLLEGE POINT NY
11356-2320
US

V. Phone/Fax

Practice location:
  • Phone: 718-391-8300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number825723
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: