Provider Demographics
NPI:1093224107
Name:LIU, JENNY (FNP, RN)
Entity Type:Individual
Prefix:MISS
First Name:JENNY
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:FNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 YORK AVE APT 19B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4860
Mailing Address - Country:US
Mailing Address - Phone:917-751-1655
Mailing Address - Fax:
Practice Address - Street 1:1320 YORK AVE APT 19B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4860
Practice Address - Country:US
Practice Address - Phone:917-751-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342237207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine