Provider Demographics
NPI:1255461729
Name:LIU, BINGREN (MD)
Entity type:Individual
Prefix:
First Name:BINGREN
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE BOX 647
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-8647
Mailing Address - Country:US
Mailing Address - Phone:585-275-8052
Mailing Address - Fax:585-275-1531
Practice Address - Street 1:1561 LONG POND RD
Practice Address - Street 2:SUITE 120
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4117
Practice Address - Country:US
Practice Address - Phone:585-225-3989
Practice Address - Fax:585-720-7748
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2322452085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYL14424Medicare UPIN
NYRA3082Medicare ID - Type Unspecified
NYRB4400Medicare PIN
NY35459AMedicare PIN