Provider Demographics
NPI:1568423093
Name:SIDDIQI, AZHER (MD)
Entity Type:Individual
Prefix:
First Name:AZHER
Middle Name:
Last Name:SIDDIQI
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 1:1147 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-2423
Mailing Address - Country:US
Mailing Address - Phone:718-668-2340
Mailing Address - Fax:718-668-2523
Practice Address - Street 1:1147 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2423
Practice Address - Country:US
Practice Address - Phone:718-668-2340
Practice Address - Fax:718-668-2523
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY175020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01090501Medicaid
A62457Medicare UPIN