Healthcare Provider Details

I. General information

NPI: 1356836191
Provider Name (Legal Business Name): JUDY LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1357 BROADWAY 505
NEW YORK NY
10018
US

IV. Provider business mailing address

1357 BROADWAY 505
NEW YORK NY
10018-7101
US

V. Phone/Fax

Practice location:
  • Phone: 347-949-8124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: