MEDICARE: MISS AMY LIU MSN, PMHNP-BC, RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	F403205-01	NY
2	163W00000X	Registered Nurse	22696034	NY

General Provider Information

NPI Number	:	1083007595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS AMY LIU MSN, PMHNP-BC, RN

Provider Business Mailing Address
First Line	:	70 BAY 20TH ST APT 2C
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-3870
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 BAY 20TH ST APT 2C
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-3870
Country	:	US
Telephone Number	:	646-239-9500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2015
Last Update Date	:	09/27/2020

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