Provider Demographics
NPI:1285663872
Name:LIU, VICKY (MD)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-235-0360
Mailing Address - Fax:585-235-1617
Practice Address - Street 1:65 GENESEE ST FL SUITE2
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-3201
Practice Address - Country:US
Practice Address - Phone:585-235-0360
Practice Address - Fax:585-235-1617
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194349208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01471383Medicaid
NYRB0054- GRP: 70008AMedicare PIN
NY01471383Medicaid
NYRB0054- GRP: 70008AMedicare PIN