Provider Demographics
NPI:1689726440
Name:SIDDIQ, RAHEEL (RD)
Entity Type:Individual
Prefix:
First Name:RAHEEL
Middle Name:
Last Name:SIDDIQ
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 HONEYMAN RD
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-3821
Mailing Address - Country:US
Mailing Address - Phone:908-470-9105
Mailing Address - Fax:908-756-5214
Practice Address - Street 1:190 GREENBROOK RD
Practice Address - Street 2:
Practice Address - City:NORTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-3903
Practice Address - Country:US
Practice Address - Phone:908-756-5206
Practice Address - Fax:908-756-5214
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ942891133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered