Organization
WISDOM MEDICAL P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISEN LIU MD (OWNER)
(718) 939-2669
Entity
Organization
Contact information
Practice address
13625 MAPLE AVE, SUITE201, FLUSHING, NY 11355-3870
(718) 939-2669
(718) 939-2663
Mailing address
13625 MAPLE AVE, SUITE201, FLUSHING, NY 11355-3870
(718) 939-2669
(718) 939-2663
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
239854
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02818487
—
NY
Enumeration date
03/28/2007
Last updated
08/22/2020
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