Provider Demographics
NPI:1972765675
Name:SIU, LARRY K (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:K
Last Name:SIU
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 1:101 OLD SHORT HILLS RD STE 217
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1023
Mailing Address - Country:US
Mailing Address - Phone:973-731-4600
Mailing Address - Fax:973-731-1477
Practice Address - Street 1:101 OLD SHORT HILLS RD STE 217
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1023
Practice Address - Country:US
Practice Address - Phone:973-731-4600
Practice Address - Fax:973-731-1477
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP01440207R00000X
NJ25MA09639900207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine