Provider Demographics
NPI:1225107121
Name:SIDDIQUI, NAFEESA (MD)
Entity Type:Individual
Prefix:
First Name:NAFEESA
Middle Name:
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 1:252 WASHINGTON VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-4823
Mailing Address - Country:US
Mailing Address - Phone:973-895-3336
Mailing Address - Fax:973-904-3163
Practice Address - Street 1:510 HAMBURG TPKE
Practice Address - Street 2:SUITE E106
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2025
Practice Address - Country:US
Practice Address - Phone:973-904-3161
Practice Address - Fax:973-904-3163
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0430412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7833105Medicaid
NJF24033Medicare UPIN
NJSI717830Medicare ID - Type Unspecified