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General NPI Number Information
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NPI Number | 1265445894
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Entity Type | Individual
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Provider Name | LISEN LIU MD
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Gender | Female
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 12/16/2015
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Provider Practice Location Address
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Address Line | 13625 MAPLE AVE SUITE 201,WISDOM MEDICAL PC
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City | FLUSHING
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State | NY
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Zip | 11355-3870
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Country | US
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Telephone | 718-939-2669
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Fax | 718-939-2663
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Provider Business Mailing Address
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Address Line | 13620 38TH AVE 6E
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City | FLUSHING
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State | NY
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Zip | 11354-4232
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Country | US
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Telephone | 718-939-2669
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Fax | 718-939-2663
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 239854
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License Number State | NY
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