Healthcare Provider Details

I. General information

NPI: 1467862854
Provider Name (Legal Business Name): QIUYI LIANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2014
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WESTCHESTER HL RM 151
STONY BROOK NY
11794-8711
US

IV. Provider business mailing address

2002 HOLCOMBE BLVD
HOUSTON TX
77030-4211
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-2557
  • Fax: 631-444-6013
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number33966
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number33966
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number058350
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: