Provider Demographics
NPI:1215032768
Name:LIU, EDMUND S (MD)
Entity Type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:S
Last Name:LIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:EDMUND
Other - Middle Name:S
Other - Last Name:LIU, MD, PA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:207 POMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-3018
Mailing Address - Country:US
Mailing Address - Phone:973-571-1933
Mailing Address - Fax:973-571-1904
Practice Address - Street 1:207 POMPTON AVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-3018
Practice Address - Country:US
Practice Address - Phone:973-571-1933
Practice Address - Fax:973-571-1904
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07394800207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H63210Medicare UPIN
058698Medicare ID - Type Unspecified