Provider Demographics
NPI:1578790531
Name:SIDDIQUI, TALHA ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:TALHA
Middle Name:ALI
Last Name:SIDDIQUI
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 1:20 OVERBROOK LN
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-2737
Mailing Address - Country:US
Mailing Address - Phone:516-209-7311
Mailing Address - Fax:
Practice Address - Street 1:1395 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-1705
Practice Address - Country:US
Practice Address - Phone:631-385-5650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4766862084P0800X, 2084P0804X
NY3143062084P0800X, 2084P0804X
AZ656322084P0800X, 2084P0804X
DEC1-00254482084P0800X, 2084P0804X
FLME1541142084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry