Basic Information
| Provider Information | |||||||||
| NPI: | 1740677004 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GU | ||||||||
| FirstName: | VERA | ||||||||
| MiddleName: | LIU | ||||||||
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| OtherLastName: | LIU | ||||||||
| OtherFirstName: | WEI | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 14929 24TH AVE | ||||||||
| Address2: | |||||||||
| City: | WHITESTONE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113573646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3473996188 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1651 CONEY ISLAND AVENUE | ||||||||
| Address2: | OMNI CHILDHOOD CENTER, | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189981415 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2015 | ||||||||
| LastUpdateDate: | 04/23/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 008629-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.