Provider Demographics
NPI:1851637136
Name:SIDDIQUI, RAHEEL A (MT)
Entity Type:Individual
Prefix:MR
First Name:RAHEEL
Middle Name:A
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 ABBEY RD
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2005
Mailing Address - Country:US
Mailing Address - Phone:856-264-7024
Mailing Address - Fax:856-210-1888
Practice Address - Street 1:124 ABBEY RD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2005
Practice Address - Country:US
Practice Address - Phone:856-264-7024
Practice Address - Fax:856-210-1888
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00419400225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist