Provider Demographics
NPI:1548615677
Name:LIAO, WEIJEI (DPM)
Entity Type:Individual
Prefix:
First Name:WEIJEI
Middle Name:
Last Name:LIAO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 HARNED RD
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-5117
Mailing Address - Country:US
Mailing Address - Phone:917-515-4614
Mailing Address - Fax:
Practice Address - Street 1:230 HILTON AVE STE 106
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-8116
Practice Address - Country:US
Practice Address - Phone:917-515-4614
Practice Address - Fax:718-224-5209
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007024213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery