Individual provider Active NPI

Che Liu, MD

  • Internal Medicine Physician
  • Flushing, NY
National Provider Identifier
1013379791
Registry record updated Dec 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
309005 Issued in NY
Practice address
13668 Roosevelt Ave Ste 2B
Flushing, NY 11354-5510
Phone
(718) 435-1025
NPI assigned
Mar 22, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Preventive Medicine/Occupational Environmental Medicine Physician 2083P0500X 25MA11105000 NJ
Internal Medicine Physician 207R00000X 309005 NY Primary

Addresses

Primary practice location

13668 Roosevelt Ave Ste 2B
Flushing, NY 11354-5510

Mailing address

79 Flagg CT
Staten Island, NY 10304-1157
Phone (646) 409-2508

Other practice location 1

595 Division St
Elizabeth, NJ 07201-2038
Phone (908) 289-5646

Other practice location 2

824 55th St
Brooklyn, NY 11220-3263
Phone (718) 435-1025

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220606000745 NY Practitioner - Internal MedicinePractitioner - Preventive Medicine 0749575587 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25MA11105000NJMDPreventive Medicine/Occupational Environmental Medicine Physician
309005NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Clear Lake Medical PC Current Accepting new patients
Polaris Care Medical PC Internal Medicine CurrentSince Jun 1, 2022 Accepting new patients

Locations

13668 Roosevelt Ave
Ste 2B
Flushing, NY 11354
Phone (646) 409-2508

93 New Dorp Ln
#1
Staten Island, NY 10306
Phone (646) 409-2508

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1458604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701475200000",
    "number": "1013379791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "79 FLAGG CT",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103041157",
            "telephone_number": "646-409-2508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13668 ROOSEVELT AVE STE 2B",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113545510",
            "telephone_number": "718-435-1025"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "595 Division St",
            "address_purpose": "LOCATION",
            "city": "Elizabeth",
            "state": "NJ",
            "postal_code": "072012038",
            "country_code": "US",
            "telephone_number": "908-289-5646",
            "fax_number": "908-351-1099",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "824 55th St",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112203263",
            "country_code": "US",
            "telephone_number": "718-435-1025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIU",
        "first_name": "CHE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-22",
        "last_updated": "2023-12-02",
        "certification_date": "2023-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083P0500X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine",
            "state": "NJ",
            "license": "25MA11105000",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "309005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flushing, NY

Sources for this page

Verify at the official NPI Registry.