Provider Demographics
NPI:1023056561
Name:SYED A. SIDDIQ, MD, LLC
Entity type:Organization
Organization Name:SYED A. SIDDIQ, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:AZHAR
Authorized Official - Last Name:SIDDIQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-756-5206
Mailing Address - Street 1:190 GREENBROOK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-3903
Mailing Address - Country:US
Mailing Address - Phone:908-756-5206
Mailing Address - Fax:908-756-5214
Practice Address - Street 1:190 GREENBROOK RD
Practice Address - Street 2:
Practice Address - City:NORTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-3903
Practice Address - Country:US
Practice Address - Phone:908-756-5206
Practice Address - Fax:908-756-5214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA062636207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6680909Medicaid
G12692Medicare UPIN
0792610Medicare ID - Type Unspecified