Provider Demographics
NPI:1437209442
Name:SIDDIQUI, MUHAMMAD GHUFRAN ALI
Entity Type:Individual
Prefix:MR
First Name:MUHAMMAD
Middle Name:GHUFRAN ALI
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 UPPER SADDLE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1043
Mailing Address - Country:US
Mailing Address - Phone:201-802-1139
Mailing Address - Fax:201-502-5113
Practice Address - Street 1:182 UPPER SADDLE RIVER RD
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645-1043
Practice Address - Country:US
Practice Address - Phone:201-802-1139
Practice Address - Fax:201-502-5113
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028998183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist