Active NPI
Wanyu Liu
- Dentist
- Medford, NY
National Provider Identifier
1134486715
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 056835
- Practice address
- 3201 Horseblock Rd
Medford, NY 11763-2545 - Phone
- (631) 730-5255
- Fax
- (631) 730-5256
- NPI assigned
- Apr 19, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 056835 | NY | Primary |
Addresses
Primary practice location
3201 Horseblock Rd
Medford, NY 11763-2545
Mailing address
3201 Horseblock Rd
Medford, NY 11763-2545
Phone (631) 730-5255
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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170927002006 | NY | Order and Referring Only - Dentist | 6709150998 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 056835 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1334793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1134486715",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3201 HORSEBLOCK RD",
"city": "MEDFORD",
"state": "NY",
"postal_code": "117632545",
"telephone_number": "631-730-5255",
"fax_number": "631-730-5256"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3201 HORSEBLOCK RD",
"city": "MEDFORD",
"state": "NY",
"postal_code": "117632545",
"telephone_number": "631-730-5255",
"fax_number": "631-730-5256"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIU",
"first_name": "WANYU",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-04-19",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "056835",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.