Healthcare Provider Details

I. General information

NPI: 1366734642
Provider Name (Legal Business Name): CORINNE C LIU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MINEOLA BLVD STE 10
MINEOLA NY
11501-4064
US

IV. Provider business mailing address

PO BOX 95000-5560
PHILADELPHIA PA
19195-5560
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-4510
  • Fax: 516-663-3698
Mailing address:
  • Phone: 865-766-8800
  • Fax: 865-766-8874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number254485
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: