Healthcare Provider Details

I. General information

NPI: 1548430903
Provider Name (Legal Business Name): MS. ELISABETH LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2008
Last Update Date: 03/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 JERUSALEM AVE
NORTH BELLMORE NY
11710-1836
US

IV. Provider business mailing address

2660 JERUSALEM AVE
NORTH BELLMORE NY
11710-1836
US

V. Phone/Fax

Practice location:
  • Phone: 516-409-0907
  • Fax: 516-409-9376
Mailing address:
  • Phone: 516-409-0907
  • Fax: 516-409-9376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number046807
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: