Provider Demographics
NPI:1346221058
Name:SHIAU, JOHN S (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:SHIAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2535 ARTHUR KILL RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-1207
Mailing Address - Country:US
Mailing Address - Phone:718-448-3210
Mailing Address - Fax:718-967-6023
Practice Address - Street 1:1099 TARGEE STREET
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4310
Practice Address - Country:US
Practice Address - Phone:718-448-3210
Practice Address - Fax:718-815-3379
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2011-06-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1915601207T00000X
NJMA067801207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01920103Medicaid
NY01920103Medicaid
NY39E771Medicare PIN