Provider Demographics
NPI:1083351795
Name:LIU, LIYU (MS LAC)
Entity Type:Individual
Prefix:
First Name:LIYU
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:MS LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14351 ROOSEVELT AVE APT 15J
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6195
Mailing Address - Country:US
Mailing Address - Phone:646-696-8581
Mailing Address - Fax:
Practice Address - Street 1:136-20 38TH AVE
Practice Address - Street 2:3F-105
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:929-371-5588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-14
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031989-01225700000X
NY007186171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY540445305OtherDRIVER LICENSE