Provider Demographics
NPI:1114187952
Name:SIDDIQUI
Entity Type:Organization
Organization Name:SIDDIQUI
Other - Org Name:SUNY DOWNSTATE
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL ASSISTANT INSTRUCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FARRUQ
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-270-8128
Mailing Address - Street 1:1025 E 14TH ST APT 2B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-4364
Mailing Address - Country:US
Mailing Address - Phone:718-270-8128
Mailing Address - Fax:
Practice Address - Street 1:1025 E 14TH ST APT 2B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4364
Practice Address - Country:US
Practice Address - Phone:718-270-8128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital