Provider Demographics
NPI:1841221124
Name:LIU, SU (MD PHD)
Entity Type:Individual
Prefix:
First Name:SU
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 WESTCHESTER VIEW LN
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-1758
Mailing Address - Country:US
Mailing Address - Phone:914-815-2935
Mailing Address - Fax:
Practice Address - Street 1:56 WESTCHESTER VIEW LN
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-1758
Practice Address - Country:US
Practice Address - Phone:914-815-2935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2154432081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH22513Medicare UPIN
NY71Z301Medicare ID - Type Unspecified