Provider Demographics
NPI:1639368160
Name:ELLE DIAGNOSTIC PA
Entity Type:Organization
Organization Name:ELLE DIAGNOSTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAQIB
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-292-1121
Mailing Address - Street 1:33300 EGYPT LN STE F200
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-2741
Mailing Address - Country:US
Mailing Address - Phone:281-292-1121
Mailing Address - Fax:832-553-3211
Practice Address - Street 1:33300 EGYPT LN STE F200
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-2741
Practice Address - Country:US
Practice Address - Phone:281-292-1121
Practice Address - Fax:832-553-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL17372084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Single Specialty