MEDICARE: JOSE W SIU MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	117889	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174693790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE W SIU MD

Provider Business Mailing Address
First Line	:	26 GAYLORD DRIVE NORTH
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-6712
Country	:	US
Telephone Number	:	718-951-2519
Fax Number	:	718-258-0654

Provider Business Practice Location Address
First Line	:	3024 AVENUE I
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-3033
Country	:	US
Telephone Number	:	718-951-2519
Fax Number	:	718-258-0654

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	07/08/2007

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