Provider Demographics
NPI:1770331399
Name:SIDDIQUI, KAMRAN
Entity type:Individual
Prefix:MR
First Name:KAMRAN
Middle Name:
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 FLINT AVE
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-7107
Mailing Address - Country:US
Mailing Address - Phone:646-578-4094
Mailing Address - Fax:718-709-4282
Practice Address - Street 1:2094 MERRICK AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3147
Practice Address - Country:US
Practice Address - Phone:516-600-0676
Practice Address - Fax:516-863-2963
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor