Provider Demographics
NPI:1649403619
Name:SIDDIQI, ATIF INAM (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:ATIF
Middle Name:INAM
Last Name:SIDDIQI
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 FILLMORE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4132
Mailing Address - Country:US
Mailing Address - Phone:718-477-2978
Mailing Address - Fax:
Practice Address - Street 1:35 FILLMORE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4132
Practice Address - Country:US
Practice Address - Phone:718-477-2978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013485363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03230917Medicaid
NYA400036568Medicare PIN