Healthcare Provider Details

I. General information

NPI: 1235148768
Provider Name (Legal Business Name): FONG LIU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 BLOOMINGDALE RD
WHITE PLAINS NY
10605-1504
US

IV. Provider business mailing address

21 BLOOMINGDALE RD
WHITE PLAINS NY
10605-1504
US

V. Phone/Fax

Practice location:
  • Phone: 914-997-4359
  • Fax:
Mailing address:
  • Phone: 914-997-4359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number225002
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: