Basic Information
| Provider Information | |||||||||
| NPI: | 1497106629 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIAQAT | ||||||||
| FirstName: | AIMEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 OLD SHORT HILLS RD APT 570 | ||||||||
| Address2: | |||||||||
| City: | WEST ORANGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070521044 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1211 UNION AVE STE 330 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381046655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014789183 | ||||||||
| FaxNumber: | 9014788957 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2016 | ||||||||
| LastUpdateDate: | 09/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 64759 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 221494440 | 01 | NJ | GME COORDINATOR | OTHER |