Healthcare Provider Details

I. General information

NPI: 1194119180
Provider Name (Legal Business Name): DIANE LIU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E 70TH ST
NEW YORK NY
10021-4872
US

IV. Provider business mailing address

575 LEXINGTON AVE STE 500
NEW YORK NY
10022-6102
US

V. Phone/Fax

Practice location:
  • Phone: 646-962-4324
  • Fax: 646-962-0246
Mailing address:
  • Phone: 212-590-5152
  • Fax: 212-590-5798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number293982-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: