Healthcare Provider Details

I. General information

NPI: 1255013918
Provider Name (Legal Business Name): SUMBUL LIAQAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARK AVE
NEW YORK NY
10016-5802
US

IV. Provider business mailing address

1 PARK AVE FL 7
NEW YORK NY
10016-5818
US

V. Phone/Fax

Practice location:
  • Phone: 646-754-5063
  • Fax:
Mailing address:
  • Phone: 646-754-5063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number346103-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: