Provider Demographics
NPI:1962676122
Name:NORTHEAST HOUSTON SPINE CENTER PA
Entity Type:Organization
Organization Name:NORTHEAST HOUSTON SPINE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MD
Authorized Official - Prefix:MR
Authorized Official - First Name:SAQIB
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-292-1121
Mailing Address - Street 1:PO BOX 132618
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77393-2618
Mailing Address - Country:US
Mailing Address - Phone:281-292-1121
Mailing Address - Fax:832-553-3211
Practice Address - Street 1:14450 T.C. JESTER
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-1331
Practice Address - Country:US
Practice Address - Phone:281-292-1121
Practice Address - Fax:832-553-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0921207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty