=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639473085
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FUTURE BRIGHT MANAGEMENT, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2010
-----------------------------------------------------
Last Update Date | 12/28/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 185 CANAL ST 6TH FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10013-4537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-343-7323
-----------------------------------------------------
Fax | 212-343-7913
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 185 CANAL ST 6TH FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10013-4537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-343-7323
-----------------------------------------------------
Fax | 212-343-7913
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | GEORGE LIU
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 212-343-7323
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number | 140475
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 140475
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------