Provider Demographics
NPI:1639109580
Name:LIAO, JENNIFER HONGXIA
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HONGXIA
Last Name:LIAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HONGXIA
Other - Middle Name:
Other - Last Name:LIAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6115 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3542
Mailing Address - Country:US
Mailing Address - Phone:917-723-5319
Mailing Address - Fax:
Practice Address - Street 1:6115 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3542
Practice Address - Country:US
Practice Address - Phone:917-723-5319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY498320163W00000X
NY003077171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse