Provider Demographics
NPI:1740486075
Name:LIANG, LUOBIN (PA-C, CCP)
Entity type:Individual
Prefix:MR
First Name:LUOBIN
Middle Name:
Last Name:LIANG
Suffix:
Gender:M
Credentials:PA-C, CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07648-1238
Mailing Address - Country:US
Mailing Address - Phone:201-538-2501
Mailing Address - Fax:740-931-1211
Practice Address - Street 1:350 ENGLE ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1808
Practice Address - Country:US
Practice Address - Phone:201-894-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-24
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MI00001800242T00000X
NY011394363A00000X
NJ25MP00158700363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant