Provider Demographics
NPI:1619166774
Name:SIDDIQI, KASHIF I (MD)
Entity Type:Individual
Prefix:
First Name:KASHIF
Middle Name:I
Last Name:SIDDIQI
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 1:740 ROUTE 1 N
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-2652
Mailing Address - Country:US
Mailing Address - Phone:732-847-2555
Mailing Address - Fax:732-807-7042
Practice Address - Street 1:740 ROUTE 1 N
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-2652
Practice Address - Country:US
Practice Address - Phone:732-847-2555
Practice Address - Fax:732-807-7042
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08276600207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0181153Medicaid
NJ0181153Medicaid
NJ134102CDYMedicare PIN
NJ134102CDZMedicare PIN