Healthcare Provider Details

I. General information

NPI: 1386649846
Provider Name (Legal Business Name): BLANCHE FUNG LIU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 MARCUS AVE STE 300
NEW HYDE PARK NY
11042-1020
US

IV. Provider business mailing address

233 CRABAPPLE RD
MANHASSET NY
11030-1710
US

V. Phone/Fax

Practice location:
  • Phone: 516-466-2340
  • Fax:
Mailing address:
  • Phone: 646-256-7901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number218040
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: