Provider Demographics
NPI:1205217973
Name:SIAU, EVAN GELENN DIO (MD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:GELENN DIO
Last Name:SIAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 E 17TH ST
Mailing Address - Street 2:FL 19, SUITE 50
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3805
Mailing Address - Country:US
Mailing Address - Phone:212-844-1808
Mailing Address - Fax:
Practice Address - Street 1:1ST AVENUE AT 16TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-844-1808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299726208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist