Provider Demographics
NPI:1720751134
Name:SINGLA, SIDDHI MITTAL (PA-C)
Entity Type:Individual
Prefix:
First Name:SIDDHI
Middle Name:MITTAL
Last Name:SINGLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SIDDHI
Other - Middle Name:
Other - Last Name:MITTAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:248 HARDING BLVD
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-2913
Mailing Address - Country:US
Mailing Address - Phone:732-915-0956
Mailing Address - Fax:
Practice Address - Street 1:248 HARDING BLVD
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-2913
Practice Address - Country:US
Practice Address - Phone:732-915-0956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA062797363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant