Healthcare Provider Details

I. General information

NPI: 1972704062
Provider Name (Legal Business Name): DIANE LIU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANE LIU M.D.

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 W 34TH ST
NEW YORK NY
10001-2320
US

IV. Provider business mailing address

460 WEST 34TH STREET
NEW YORK NY
10001
US

V. Phone/Fax

Practice location:
  • Phone: 212-273-6100
  • Fax:
Mailing address:
  • Phone: 212-273-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number249453
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: