Provider Demographics
NPI:1801206396
Name:SIDDIQUI, KAMRAN
Entity Type:Individual
Prefix:
First Name:KAMRAN
Middle Name:
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 STATE ROUTE 33
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07754
Mailing Address - Country:US
Mailing Address - Phone:732-776-4483
Mailing Address - Fax:732-776-4798
Practice Address - Street 1:1945 STATE ROUTE 33
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07754
Practice Address - Country:US
Practice Address - Phone:732-776-4483
Practice Address - Fax:732-776-4798
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10065200208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist