Healthcare Provider Details

I. General information

NPI: 1285607010
Provider Name (Legal Business Name): SPENCER S LIU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E 70TH ST DEPT 853W
NEW YORK NY
10021-4823
US

IV. Provider business mailing address

PO BOX 27578
NEW YORK NY
10087-7578
US

V. Phone/Fax

Practice location:
  • Phone: 212-606-1036
  • Fax: 212-517-4481
Mailing address:
  • Phone: 631-329-6925
  • Fax: 631-329-6951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD00030930
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number240387
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: