Basic Information
Provider Information | |||||||||
NPI: | 1518054188 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LIU | ||||||||
FirstName: | CHRISTER | ||||||||
MiddleName: | S. | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 13620 38TH AVE | ||||||||
Address2: | SUITE 5I | ||||||||
City: | FLUSHING | ||||||||
State: | NY | ||||||||
PostalCode: | 113544233 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7189399200 | ||||||||
FaxNumber: | 7189397474 | ||||||||
Practice Location | |||||||||
Address1: | 13620 38TH AVE | ||||||||
Address2: | SUITE 5I | ||||||||
City: | FLUSHING | ||||||||
State: | NY | ||||||||
PostalCode: | 113544233 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7189399200 | ||||||||
FaxNumber: | 7189397474 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/06/2006 | ||||||||
LastUpdateDate: | 06/11/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 111401 | NY | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology |   |
ID Information
ID | Type | State | Issuer | Description | 7611899 | 01 | NY | AETNA PPO | OTHER | 3229272 | 01 | NY | AETNA HMO | OTHER | 7611899 | 01 | NY | AETNAPPO | OTHER | CL00432T10 | 01 | NY | BC&BS PIN | OTHER | 000000110400 | 01 | NY | GHI HMO | OTHER | 00563608 | 05 | NY |   | MEDICAID | 4229964 | 01 | NY | AETNA CHICKMAG | OTHER | 0432T1 | 01 | NY | BLUE CROSS & BLUE SHEILD | OTHER | 3229272 | 01 | NY | AETNAHMO | OTHER |