Provider Demographics
NPI:1790281574
Name:SIDDIQUE, HASEEB (MD)
Entity Type:Individual
Prefix:
First Name:HASEEB
Middle Name:
Last Name:SIDDIQUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 MOUNT SINAI CORAM RD
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-2405
Mailing Address - Country:US
Mailing Address - Phone:631-836-8707
Mailing Address - Fax:
Practice Address - Street 1:96 MOUNT SINAI CORAM RD
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-2405
Practice Address - Country:US
Practice Address - Phone:631-836-8707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY313500207R00000X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program