Healthcare Provider Details

I. General information

NPI: 1689565178
Provider Name (Legal Business Name): JENNIFER GM LIANG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W 42ND ST
NEW YORK NY
10036-8005
US

IV. Provider business mailing address

33 W 42ND ST
NEW YORK NY
10036-8005
US

V. Phone/Fax

Practice location:
  • Phone: 212-938-4000
  • Fax:
Mailing address:
  • Phone: 212-938-4001
  • Fax: 212-938-5831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number011219
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: