=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376676049
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JING LIU M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2007
-----------------------------------------------------
Last Update Date | 12/11/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 CHARLES LINDBERGH BLVD
-----------------------------------------------------
City | UNIONDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11553-3658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-512-5200
-----------------------------------------------------
Fax | 516-512-5301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 CHARLES LINDBERGH BLVD
-----------------------------------------------------
City | UNIONDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11553-3631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-512-5200
-----------------------------------------------------
Fax | 516-512-5301
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 212599-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------