Healthcare Provider Details

I. General information

NPI: 1790907103
Provider Name (Legal Business Name): JIABIN LIU MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E 70TH ST
NEW YORK NY
10021
US

IV. Provider business mailing address

PO BOX 27578
NEW YORK NY
10087-4823
US

V. Phone/Fax

Practice location:
  • Phone: 212-606-1206
  • Fax: 212-517-4481
Mailing address:
  • Phone: 844-268-4820
  • Fax: 631-201-3179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number287055
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: