Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 224221 | NY |
NPI | 1013983238 |
---|---|
Provider Name | Mr. Jeffrey Liu |
First Address | Mineola, NY 11501-1502 |
Second Address | Mineola, NY 11501-1502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 19/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I34714 | (02) |