1285607010 NPI number — DR. SPENCER S LIU MD

Table of content: DR. SPENCER S LIU MD (NPI 1285607010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285607010 NPI number — DR. SPENCER S LIU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIU
Provider First Name:
SPENCER
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285607010
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27578
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10087-7578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-329-6925
Provider Business Mailing Address Fax Number:
631-329-6951

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
535 E 70TH ST
Provider Second Line Business Practice Location Address:
DEPT 853W
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10021-4823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-606-1036
Provider Business Practice Location Address Fax Number:
212-517-4481
Provider Enumeration Date:
02/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  MD00030930 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 240387 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02868546 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1285607010 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0296480 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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