Provider Demographics
NPI:1841095627
Name:SOUTHSIDE NEONATAL CARE PC
Entity type:Organization
Organization Name:SOUTHSIDE NEONATAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:FOAZIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-335-7663
Mailing Address - Street 1:800 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4917
Mailing Address - Country:US
Mailing Address - Phone:631-563-2294
Mailing Address - Fax:631-589-8946
Practice Address - Street 1:800 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4917
Practice Address - Country:US
Practice Address - Phone:631-563-2294
Practice Address - Fax:631-589-8946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care