Healthcare Provider Details

I. General information

NPI: 1588956908
Provider Name (Legal Business Name): GRACE LIU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2011
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 W 72ND ST
NEW YORK NY
10023-4119
US

IV. Provider business mailing address

40 W 72ND ST
NEW YORK NY
10023-4119
US

V. Phone/Fax

Practice location:
  • Phone: 212-981-9800
  • Fax:
Mailing address:
  • Phone: 212-981-9800
  • Fax: 212-981-9818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number264457
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: