Healthcare Provider Details

I. General information

NPI: 1154580199
Provider Name (Legal Business Name): SOPHIA LIU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 WESTCHESTER AVE
PURCHASE NY
10577
US

IV. Provider business mailing address

2700 WESTCHESTER AVE
PURCHASE NY
10577-2547
US

V. Phone/Fax

Practice location:
  • Phone: 914-682-6466
  • Fax: 914-681-5222
Mailing address:
  • Phone: 914-607-5730
  • Fax: 914-457-1195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number258702
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: