Provider Demographics
NPI:1720377583
Name:SIDDIQUI, ADEEL (MBBS)
Entity Type:Individual
Prefix:DR
First Name:ADEEL
Middle Name:
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 COMMACK RD
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-8210
Mailing Address - Country:US
Mailing Address - Phone:631-741-7316
Mailing Address - Fax:
Practice Address - Street 1:848 ADAMS AVE GROUND FL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103
Practice Address - Country:US
Practice Address - Phone:901-287-7337
Practice Address - Fax:901-287-6042
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN503982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology