Provider Demographics
NPI:1104865807
Name:LIU, MINI ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:MINI
Middle Name:ANN
Last Name:LIU
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:135 EASTERN PKWY
Mailing Address - Street 2:APT#131
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-6054
Mailing Address - Country:US
Mailing Address - Phone:718-857-2849
Mailing Address - Fax:212-238-7009
Practice Address - Street 1:227 MADISON ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-7537
Practice Address - Country:US
Practice Address - Phone:212-238-7614
Practice Address - Fax:212-238-7009
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY139770207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC11610Medicare UPIN