=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114256641
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABC PSYCHIATRIC CONSULTANT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2009
-----------------------------------------------------
Last Update Date | 12/11/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31 MOUNTAIN BLVD SUITE 31W
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07059-5644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-769-8582
-----------------------------------------------------
Fax | 908-222-1780
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 115 PARLIN LN
-----------------------------------------------------
City | WATCHUNG
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07069-5400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-222-1532
-----------------------------------------------------
Fax | 908-222-1780
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. QINYUE LIU
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 908-222-1532
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number | 25 MA07175700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------