Provider Demographics
NPI:1225028376
Name:SIDDIQUI, HENA ALVI (MD)
Entity Type:Individual
Prefix:
First Name:HENA
Middle Name:ALVI
Last Name:SIDDIQUI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 WAGONWHEEL CT
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746
Mailing Address - Country:US
Mailing Address - Phone:631-608-5629
Mailing Address - Fax:631-236-9695
Practice Address - Street 1:399 COUNTYLINE RD
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701
Practice Address - Country:US
Practice Address - Phone:631-608-5629
Practice Address - Fax:631-795-2975
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189862-1207R00000X, 207RG0300X
NY189862207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01403992Medicaid
49H961Medicare ID - Type Unspecified
NY01403992Medicaid