Provider Demographics
NPI:1558553263
Name:SIDDIQUI, SAMINA (MD)
Entity Type:Individual
Prefix:
First Name:SAMINA
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 1:17 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-3841
Mailing Address - Country:US
Mailing Address - Phone:281-804-0457
Mailing Address - Fax:
Practice Address - Street 1:24302 NORTHEN BLVD
Practice Address - Street 2:
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11362-1199
Practice Address - Country:US
Practice Address - Phone:718-423-6200
Practice Address - Fax:718-423-9762
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP99602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty