Provider Demographics
NPI:1538243761
Name:LIEN, STEVEN THAI (RPH)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:THAI
Last Name:LIEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25-01 30AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102
Mailing Address - Country:US
Mailing Address - Phone:718-278-8300
Mailing Address - Fax:718-278-8960
Practice Address - Street 1:2501 30TH AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-2447
Practice Address - Country:US
Practice Address - Phone:718-278-8300
Practice Address - Fax:718-278-8960
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00262175Medicaid
NY00262175Medicaid