Provider Demographics
NPI:1609843671
Name:PANDYA, SIDDHARTH T (MD)
Entity Type:Individual
Prefix:
First Name:SIDDHARTH
Middle Name:T
Last Name:PANDYA
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 1:3 EMBRY FARM RD
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1081
Mailing Address - Country:US
Mailing Address - Phone:718-418-6040
Mailing Address - Fax:718-418-6047
Practice Address - Street 1:374 STOCKHOLM ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4006
Practice Address - Country:US
Practice Address - Phone:718-418-6040
Practice Address - Fax:718-418-6047
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189510207R00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01707395Medicaid
NYG41889Medicare UPIN
NY17N452Medicare PIN