Healthcare Provider Details

I. General information

NPI: 1316628324
Provider Name (Legal Business Name): CHANGXIANG LIU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 DRYSDALE ST
STATEN ISLAND NY
10314-5010
US

IV. Provider business mailing address

44 DRYSDALE ST
STATEN ISLAND NY
10314-5010
US

V. Phone/Fax

Practice location:
  • Phone: 646-675-0124
  • Fax:
Mailing address:
  • Phone: 646-675-0124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number032956
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: