Provider Demographics
NPI:1033252812
Name:SIDDIQUI, QURRATULAIN TABASSUM (MD)
Entity Type:Individual
Prefix:DR
First Name:QURRATULAIN
Middle Name:TABASSUM
Last Name:SIDDIQUI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 ROME AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4319
Mailing Address - Country:US
Mailing Address - Phone:718-720-6394
Mailing Address - Fax:718-727-4799
Practice Address - Street 1:61 ROME AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4319
Practice Address - Country:US
Practice Address - Phone:718-720-6394
Practice Address - Fax:718-727-4799
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168734207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01108516Medicaid
D92098Medicare UPIN
00F601Medicare ID - Type Unspecified