Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | MB05221400 | NJ |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 25MB05221400 | NJ |
NPI | 1073549135 |
---|---|
Provider Name | Dwayne W Siu |
First Address | East Brunswick, NJ 08816 |
Second Address | East Brunswick, NJ 08816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 28/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F31076 | (02) |