Provider Demographics
NPI:1376728550
Name:SIDIQI, LEE SARAH (FNP)
Entity Type:Individual
Prefix:MS
First Name:LEE
Middle Name:SARAH
Last Name:SIDIQI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 STOKES RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-2913
Mailing Address - Country:US
Mailing Address - Phone:609-953-0908
Mailing Address - Fax:609-953-5978
Practice Address - Street 1:622 STOKES RD
Practice Address - Street 2:SUITE A
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2913
Practice Address - Country:US
Practice Address - Phone:609-953-0908
Practice Address - Fax:609-953-5978
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR16065700363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NR16065700OtherMEDICAL LICENSE NUMBER
NJ356118Medicare PIN