Provider Demographics
NPI:1053444638
Name:NAUSHIN SIDDIQUI PHYSICIAN PC
Entity Type:Organization
Organization Name:NAUSHIN SIDDIQUI PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMAL
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-380-8810
Mailing Address - Street 1:7729 141ST ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3293
Mailing Address - Country:US
Mailing Address - Phone:718-380-8810
Mailing Address - Fax:
Practice Address - Street 1:7729 141ST ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3293
Practice Address - Country:US
Practice Address - Phone:718-380-8810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220368207R00000X
NY221632207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05295GMedicare ID - Type Unspecified
NYH64335Medicare UPIN
NY05167Medicare ID - Type Unspecified
NYH60641Medicare UPIN