Healthcare Provider Details

I. General information

NPI: 1871917237
Provider Name (Legal Business Name): MARISELA CHAN LIU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 UNION SQ W FL 7
NEW YORK NY
10003-3304
US

IV. Provider business mailing address

19 UNION SQ W 7TH FLOOR
NEW YORK NY
10003-3304
US

V. Phone/Fax

Practice location:
  • Phone: 212-627-9600
  • Fax:
Mailing address:
  • Phone: 212-627-9600
  • Fax: 212-627-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number641570
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: