Provider Demographics
NPI:1376676049
Name:LIU, JING (MD)
Entity Type:Individual
Prefix:
First Name:JING
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 CHARLES LINDBERGH BLVD
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-3631
Mailing Address - Country:US
Mailing Address - Phone:516-512-5200
Mailing Address - Fax:516-512-5301
Practice Address - Street 1:100 CHARLES LINDBERGH BLVD
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3658
Practice Address - Country:US
Practice Address - Phone:516-512-5200
Practice Address - Fax:516-512-5301
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212599-1291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory