Individual
LISEN LIU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
13625 MAPLE AVE, SUITE 201,WISDOM MEDICAL PC, FLUSHING, NY 11355-3870
(718) 939-2669
(718) 939-2663
Mailing address
13620 38TH AVE 6E, FLUSHING, NY 11354-4232
(718) 939-2669
(718) 939-2663
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
239854
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02819487
—
NY
01
—
20-8142542
TAX IDENTIFICATION
NY
Enumeration date
08/14/2006
Last updated
12/16/2015
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