Provider Demographics
NPI:1386649846
Name:FUNG LIU, BLANCHE (MD)
Entity Type:Individual
Prefix:DR
First Name:BLANCHE
Middle Name:
Last Name:FUNG 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 1:233 CRABAPPLE RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1710
Mailing Address - Country:US
Mailing Address - Phone:646-256-7901
Mailing Address - Fax:
Practice Address - Street 1:1999 MARCUS AVE STE 300
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1020
Practice Address - Country:US
Practice Address - Phone:516-466-2340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218040174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
I30149Medicare UPIN
4V5731Medicare ID - Type Unspecified