Healthcare Provider Details

I. General information

NPI: 1922610237
Provider Name (Legal Business Name): YIFENG (IRIS) LIU RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 3RD AVE APT 509
MINEOLA NY
11501-4340
US

IV. Provider business mailing address

1 3RD AVE APT 509
MINEOLA NY
11501-4340
US

V. Phone/Fax

Practice location:
  • Phone: 516-567-8839
  • Fax:
Mailing address:
  • Phone: 516-567-8839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: