Basic Information
| Provider Information | |||||||||
| NPI: | 1861636680 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHRISTER SHANG LIU, M.D. P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 270 | ||||||||
| Address2: | |||||||||
| City: | MASSAPEQUA PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117620270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312642035 | ||||||||
| FaxNumber: | 6312641418 | ||||||||
| Practice Location | |||||||||
| Address1: | 13620 38TH AVE | ||||||||
| Address2: | SUITE 5I | ||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113544233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189399200 | ||||||||
| FaxNumber: | 7189397474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2009 | ||||||||
| LastUpdateDate: | 04/23/2009 | ||||||||
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| AuthorizedOfficialLastName: | LIU | ||||||||
| AuthorizedOfficialFirstName: | CHRISTER | ||||||||
| AuthorizedOfficialMiddleName: | SHANG | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7189399200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 111401 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.