Provider Demographics
NPI:1598795361
Name:SIDDIQUI, JAMAL AHMED (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMAL
Middle Name:AHMED
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 1:7729 141ST ST
Mailing Address - Street 2:11367 3293
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3293
Mailing Address - Country:US
Mailing Address - Phone:718-380-0810
Mailing Address - Fax:
Practice Address - Street 1:7729 141ST ST
Practice Address - Street 2:11367 3293
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3293
Practice Address - Country:US
Practice Address - Phone:718-380-0810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220368207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH60641Medicare UPIN
NY05167Medicare ID - Type Unspecified