Provider Demographics
NPI:1740677004
Name:GU, VERA LIU
Entity type:Individual
Prefix:
First Name:VERA
Middle Name:LIU
Last Name:GU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WEI
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14929 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3646
Mailing Address - Country:US
Mailing Address - Phone:347-399-6188
Mailing Address - Fax:
Practice Address - Street 1:1651 CONEY ISLAND AVENUE
Practice Address - Street 2:OMNI CHILDHOOD CENTER,
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230
Practice Address - Country:US
Practice Address - Phone:718-998-1415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008629-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant