Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 22DI02463300 | NJ |
NPI | 1104120153 |
---|---|
Provider Name | Ben Liu |
First Address | Jersey City, NJ 07302-7321 |
Second Address | Hackensack, NJ 07601-4712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2011 |
Last Update Date | 05/01/2011 |