Provider Demographics
NPI:1578501565
Name:SIDDIQ, SYED AZHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:AZHAR
Last Name:SIDDIQ
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 1:190 GREENBROOK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-3903
Mailing Address - Country:US
Mailing Address - Phone:908-756-5206
Mailing Address - Fax:908-756-5214
Practice Address - Street 1:190 GREENBROOK RD
Practice Address - Street 2:
Practice Address - City:NORTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-3903
Practice Address - Country:US
Practice Address - Phone:908-756-5206
Practice Address - Fax:908-756-5214
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA062636207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6680909Medicaid
G12692Medicare UPIN
NJ6680909Medicaid