Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 25MA08434200 | NJ |
N | 111NI0900X | Internist | 25MA08434200 | NJ |
Y | 207RN0300X | Nephrologist | 25MA08434200 | NJ |
NPI | 1063668895 |
---|---|
Provider Name | Dr. Albert Siu |
First Address | Caldwell, NJ 07006-5564 |
Second Address | Caldwell, NJ 07006-5564 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2008 |
Last Update Date | 12/01/2012 |