Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 25MA07394800 | NJ |
NPI | 1215032768 |
---|---|
Provider Name | Dr. Edmund S. Liu |
First Address | Verona, NJ 07044-3018 |
Second Address | Verona, NJ 07044-3018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 02/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H63210 | (02) |