Provider Demographics
NPI:1780008367
Name:SIDDIKI, FIRDAUS
Entity type:Individual
Prefix:MISS
First Name:FIRDAUS
Middle Name:
Last Name:SIDDIKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 LOGAN AVE # 1
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-6933
Mailing Address - Country:US
Mailing Address - Phone:732-666-4454
Mailing Address - Fax:
Practice Address - Street 1:35 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3061
Practice Address - Country:US
Practice Address - Phone:646-577-1054
Practice Address - Fax:646-200-5064
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034919-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist