Provider Demographics
NPI:1578142196
Name:SIDDIQUI, LAILA
Entity Type:Individual
Prefix:
First Name:LAILA
Middle Name:
Last Name:SIDDIQUI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 FRONT ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-4232
Mailing Address - Country:US
Mailing Address - Phone:201-312-4953
Mailing Address - Fax:
Practice Address - Street 1:479 FRONT ST APT 2F
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4232
Practice Address - Country:US
Practice Address - Phone:201-312-4953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program