Provider Demographics
NPI:1073549135
Name:SIU, DWAYNE W (DO)
Entity Type:Individual
Prefix:
First Name:DWAYNE
Middle Name:W
Last Name:SIU
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:593 CRANBURY ROAD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816
Mailing Address - Country:US
Mailing Address - Phone:732-390-3333
Mailing Address - Fax:732-390-9244
Practice Address - Street 1:593 CRANBURY ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816
Practice Address - Country:US
Practice Address - Phone:732-390-3333
Practice Address - Fax:732-390-9244
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2017-02-28
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Provider Licenses
StateLicense IDTaxonomies
NJMB05221400207RC0000X
NJ25MB05221400207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ728059Medicare PIN
F31076Medicare UPIN