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General NPI Number Information
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NPI Number | 1417172164
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Entity Type | Organization
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Legal Business Name | PARK EAST SPORTS MEDICINE & REHABILITATION PC
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 02/02/2015
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Provider Practice Location Address
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Address Line | 888 PARK AVE
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City | NEW YORK
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State | NY
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Zip | 10075
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Country | US
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Telephone | 212-427-7000
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Fax | 212-427-0200
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Provider Business Mailing Address
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Address Line | 888 PARK AVE 1D
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City | NEW YORK
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State | NY
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Zip | 10075-0235
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Country | US
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Telephone | 212-427-7000
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Fax | 212-427-0200
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Authorized Official
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Title or Position | OWNER
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Name | DR. EUGENE J LIU
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Credential | M.D.
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Telephone | 212-427-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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