Healthcare Provider Details

I. General information

NPI: 1457746190
Provider Name (Legal Business Name): MENGYUAN LIU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 YORK AVE # 1215
NEW YORK NY
10065-6007
US

IV. Provider business mailing address

1275 YORK AVE # 1215
NEW YORK NY
10065-6007
US

V. Phone/Fax

Practice location:
  • Phone: 212-639-3180
  • Fax:
Mailing address:
  • Phone: 212-639-3180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA12324500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number313740-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: