Provider Demographics
NPI:1255467064
Name:SIDDIQUI, AFZAAL AHMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:AFZAAL
Middle Name:AHMAD
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 1:31 KING PL
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-2943
Mailing Address - Country:US
Mailing Address - Phone:201-784-1565
Mailing Address - Fax:
Practice Address - Street 1:GARDEN STATE ENDOSCOPY & SURGERY CENTER
Practice Address - Street 2:1700 GALLOPING HILL ROAD
Practice Address - City:KENILWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07033
Practice Address - Country:US
Practice Address - Phone:908-241-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07033800207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H28480Medicare UPIN
043826Medicare ID - Type Unspecified