Healthcare Provider Details

I. General information

NPI: 1710338942
Provider Name (Legal Business Name): RICHARD LIU D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 CHAMBERS ST
NEW YORK NY
10007-1805
US

IV. Provider business mailing address

1345 RXR PLZ FL 13
UNIONDALE NY
11556-1301
US

V. Phone/Fax

Practice location:
  • Phone: 212-335-0594
  • Fax: 212-335-0954
Mailing address:
  • Phone: 516-453-0435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number290686
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: