Provider Demographics
NPI:1497784920
Name:SIDDIQUE, MUHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:
Last Name:SIDDIQUE
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 1:8 HANSEN DR
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1676
Mailing Address - Country:US
Mailing Address - Phone:732-750-1180
Mailing Address - Fax:732-750-1182
Practice Address - Street 1:415 AVENEL ST
Practice Address - Street 2:SUITE A
Practice Address - City:AVENEL
Practice Address - State:NJ
Practice Address - Zip Code:07001-1147
Practice Address - Country:US
Practice Address - Phone:732-750-1180
Practice Address - Fax:732-750-1182
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA67664208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD07463600OtherCDS NUMBER
NJ7797001Medicaid
NJMA67664OtherSTATE LICENCE
NJMA67664OtherSTATE LICENCE
NJ7797001Medicaid
NJ021253Medicare ID - Type UnspecifiedMEDICARE