Provider Demographics
NPI:1104271469
Name:LIU, GASTON MIKE (DPM)
Entity type:Individual
Prefix:DR
First Name:GASTON
Middle Name:MIKE
Last Name:LIU
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:57 SOUTHERN BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1091
Mailing Address - Country:US
Mailing Address - Phone:631-634-5448
Mailing Address - Fax:
Practice Address - Street 1:366 VETERANS MEMORIAL HWY STE 9
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4351
Practice Address - Country:US
Practice Address - Phone:631-836-6651
Practice Address - Fax:631-883-6636
Is Sole Proprietor?:No
Enumeration Date:2016-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYN007083213ES0103X
NYN007083-01213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery