Provider Demographics
NPI:1780797423
Name:FAISAL, SIDDIQ A (MD)
Entity type:Individual
Prefix:DR
First Name:SIDDIQ
Middle Name:A
Last Name:FAISAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1445 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3834
Mailing Address - Country:US
Mailing Address - Phone:609-587-6661
Mailing Address - Fax:609-587-8503
Practice Address - Street 1:1445 WHITEHORSE MERCERVILLE ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619
Practice Address - Country:US
Practice Address - Phone:609-587-6661
Practice Address - Fax:609-857-8503
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2021-04-29
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07961600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0238937Medicaid