Provider Demographics
NPI:1649403619
Name:SIDDIQI, ATIF INAM (RPA-C)
Entity type:Individual
Prefix:MR
First Name:ATIF
Middle Name:INAM
Last Name:SIDDIQI
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HAMILTON HEALTH PL
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3542
Mailing Address - Country:US
Mailing Address - Phone:609-584-6666
Mailing Address - Fax:609-584-6428
Practice Address - Street 1:16 CHAMBRY COURT
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728
Practice Address - Country:US
Practice Address - Phone:732-637-8003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00226500363A00000X
NY013485363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03230917Medicaid
NYA400036568Medicare PIN