Provider Demographics
NPI:1639187503
Name:SIDDIQUI, ASMA (MD)
Entity Type:Individual
Prefix:DR
First Name:ASMA
Middle Name:
Last Name:SIDDIQUI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1865 VETERANS PARK DR STE 101
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-0447
Mailing Address - Country:US
Mailing Address - Phone:239-254-7778
Mailing Address - Fax:855-959-1692
Practice Address - Street 1:7117 CONGDON ROAD
Practice Address - Street 2:200
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908
Practice Address - Country:US
Practice Address - Phone:239-254-7778
Practice Address - Fax:855-959-1692
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07807000208100000X
FLME150085208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02335486Medicaid
NJ096502SWGMedicare ID - Type Unspecified
NY02335486Medicaid