Healthcare Provider Details

I. General information

NPI: 1083077382
Provider Name (Legal Business Name): AUDUN JOACHIM LIER M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 MIDDLEVILLE RD RM 111
NORTHPORT NY
11768-2296
US

IV. Provider business mailing address

79 MIDDLEVILLE RD RM 111
NORTHPORT NY
11768-2296
US

V. Phone/Fax

Practice location:
  • Phone: 631-261-4400
  • Fax:
Mailing address:
  • Phone: 631-261-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number310054-01
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number310054-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: