Healthcare Provider Details

I. General information

NPI: 1417306291
Provider Name (Legal Business Name): LILLY YANG LIU M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2016
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5141 BROADWAY
NEW YORK NY
10034-1159
US

IV. Provider business mailing address

5141 BROADWAY
NEW YORK NY
10034-1159
US

V. Phone/Fax

Practice location:
  • Phone: 212-932-4200
  • Fax:
Mailing address:
  • Phone: 212-932-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number307928
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: