Provider Demographics
NPI:1043645526
Name:SIDDIQUI, AJAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:AJAZ
Middle Name:
Last Name:SIDDIQUI
Suffix:
Gender:M
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:PO BOX 27957
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0957
Mailing Address - Country:US
Mailing Address - Phone:908-835-1910
Mailing Address - Fax:908-835-1924
Practice Address - Street 1:755 MEMORIAL PKWY
Practice Address - Street 2:BLDG. 200 SUITE 201
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2748
Practice Address - Country:US
Practice Address - Phone:908-835-1910
Practice Address - Fax:908-835-1924
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD446928207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology