Provider Demographics
NPI:1821258708
Name:LIU, CONNIE SUE (MD)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:SUE
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 1:420 E 58TH ST
Mailing Address - Street 2:APARTMENT 18B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2345
Mailing Address - Country:US
Mailing Address - Phone:212-982-0088
Mailing Address - Fax:
Practice Address - Street 1:115 E 23RD ST
Practice Address - Street 2:FLOOR 10
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4508
Practice Address - Country:US
Practice Address - Phone:212-982-0088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242806174400000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No174400000XOther Service ProvidersSpecialist