Provider Demographics
NPI:1932385499
Name:ARSHAD J SIDDIQUI, INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:ARSHAD J SIDDIQUI, INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARSHAD
Authorized Official - Middle Name:JAMIL
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-782-1810
Mailing Address - Street 1:532 COFFEEN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2421
Mailing Address - Country:US
Mailing Address - Phone:315-782-1810
Mailing Address - Fax:315-782-1141
Practice Address - Street 1:532 COFFEEN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2421
Practice Address - Country:US
Practice Address - Phone:315-782-1810
Practice Address - Fax:315-782-1141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125702207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00464122Medicaid
NY00249000OtherRAILROAD MEDICARE
NY76037OtherGHI
NY00249000OtherRAILROAD MEDICARE
NYB78714Medicare UPIN