Provider Demographics
NPI:1154310183
Name:SIDDIQUI, SAEED A (MD)
Entity Type:Individual
Prefix:
First Name:SAEED
Middle Name:A
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 1:1 HEALTHY WAY
Mailing Address - Street 2:ATTN: PHYSICIAN BILLING
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-1551
Mailing Address - Country:US
Mailing Address - Phone:516-255-1600
Mailing Address - Fax:516-255-4672
Practice Address - Street 1:1 HEALTHY WAY
Practice Address - Street 2:ATTN: PHYSICIAN BILLING
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-1551
Practice Address - Country:US
Practice Address - Phone:516-255-1600
Practice Address - Fax:516-255-4672
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213042207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02057303Medicaid
NY02057303Medicaid
NY49C271Medicare ID - Type Unspecified