Provider Demographics
NPI:1912091349
Name:LIAO, WEI (MD)
Entity Type:Individual
Prefix:DR
First Name:WEI
Middle Name:
Last Name:LIAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:WEI
Other - Last Name:LIAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:130 HILL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3829
Mailing Address - Country:US
Mailing Address - Phone:516-672-1524
Mailing Address - Fax:
Practice Address - Street 1:13107 40TH RD STE E23
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5205
Practice Address - Country:US
Practice Address - Phone:347-438-1609
Practice Address - Fax:347-438-1663
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215420207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0296651Medicaid
NYH17222Medicare UPIN
NY10457QMedicare ID - Type Unspecified