Healthcare Provider Details

I. General information

NPI: 1417819970
Provider Name (Legal Business Name): DEFIANCE MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 W 36TH ST FL 5
NEW YORK NY
10018-9776
US

IV. Provider business mailing address

6278 FOREST AVE FL 2
RIDGEWOOD NY
11385-2010
US

V. Phone/Fax

Practice location:
  • Phone: 929-314-0119
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. XIAO WEI LIU
Title or Position: FOUNDER
Credential: MD
Phone: 646-750-0069