Provider Demographics
NPI:1750636635
Name:SIDDIQUE, KHAWAJA ASIM (MD)
Entity type:Individual
Prefix:DR
First Name:KHAWAJA
Middle Name:ASIM
Last Name:SIDDIQUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:235 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2034
Mailing Address - Country:US
Mailing Address - Phone:516-671-7770
Mailing Address - Fax:516-671-6372
Practice Address - Street 1:235 FOREST AVE
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2034
Practice Address - Country:US
Practice Address - Phone:516-671-7770
Practice Address - Fax:516-671-6372
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2025-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY280349202D00000X, 2083B0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine