Active NPI
Bonita Shadanelle Baylon Liu, DPT, PT
- Physical Therapist
- Forest Hills, NY
National Provider Identifier
1851048755
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 045638
- Practice address
- 6860 Austin St Ste 307
Forest Hills, NY 11375-4223 - Phone
- (718) 880-1716
- Fax
- (718) 880-1322
- NPI assigned
- Mar 10, 2022
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 045638 | NY | Primary |
Addresses
Primary practice location
6860 Austin St Ste 307
Forest Hills, NY 11375-4223
Mailing address
3723 63Rd St
Woodside, NY 11377-2625
Phone (516) 912-5109
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 045638 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1646870400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1646870400000",
"number": "1851048755",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3723 63RD ST",
"city": "WOODSIDE",
"state": "NY",
"postal_code": "113772625",
"telephone_number": "516-912-5109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6860 AUSTIN ST STE 307",
"city": "FOREST HILLS",
"state": "NY",
"postal_code": "113754223",
"telephone_number": "718-880-1716",
"fax_number": "718-880-1322"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIU",
"first_name": "BONITA SHADANELLE",
"middle_name": "BAYLON",
"credential": "DPT, PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-03-10",
"last_updated": "2022-03-10",
"certification_date": "2022-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "045638",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Forest Hills, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.