Provider Demographics
NPI:1164052908
Name:SIDAOUI CORP
Entity Type:Organization
Organization Name:SIDAOUI CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDAOUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-446-3323
Mailing Address - Street 1:27 KINGSLAND AVE APT 2L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-1551
Mailing Address - Country:US
Mailing Address - Phone:407-446-3323
Mailing Address - Fax:
Practice Address - Street 1:27 KINGSLAND AVE APT 2L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-1551
Practice Address - Country:US
Practice Address - Phone:407-446-3323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY293644OtherMEDICAL LIC