Provider Demographics
NPI:1972677763
Name:SIDDIQI, OMAR (DMD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:SIDDIQI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652
Mailing Address - Country:US
Mailing Address - Phone:973-715-0214
Mailing Address - Fax:
Practice Address - Street 1:220 5TH ST
Practice Address - Street 2:SADDLE BROOK
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-6216
Practice Address - Country:US
Practice Address - Phone:973-478-1616
Practice Address - Fax:973-478-1732
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0531371122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ02813147Medicaid