Provider Demographics
NPI:1750314803
Name:MIAO, SUN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUN
Middle Name:
Last Name:MIAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29 S NEW YORK RD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9692
Mailing Address - Country:US
Mailing Address - Phone:609-404-1823
Mailing Address - Fax:609-404-1853
Practice Address - Street 1:29 S NEW YORK RD
Practice Address - Street 2:SUITE 700
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9692
Practice Address - Country:US
Practice Address - Phone:609-404-1823
Practice Address - Fax:609-404-1853
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA068603207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7954808Medicaid
NJ026620Medicare PIN
G82922Medicare UPIN