Healthcare Provider Details

I. General information

NPI: 1417368499
Provider Name (Legal Business Name): SAMEER AHMED SIDDIQI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 02/15/2021
Certification Date: 02/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WESCOTT DR
FLEMINGTON NJ
08822-4603
US

IV. Provider business mailing address

2100 WESCOTT DR
FLEMINGTON NJ
08822-4603
US

V. Phone/Fax

Practice location:
  • Phone: 908-788-6410
  • Fax: 908-788-6361
Mailing address:
  • Phone: 315-271-9422
  • Fax: 732-776-4798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number25MB10560200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: