Healthcare Provider Details

I. General information

NPI: 1578740197
Provider Name (Legal Business Name): ZEHRA SIDDIQUI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PERRINE RD SUITE 229
OLD BRIDGE NJ
08857-2842
US

IV. Provider business mailing address

200 PERRINE RD SUITE 229
OLD BRIDGE NJ
08857-2842
US

V. Phone/Fax

Practice location:
  • Phone: 732-727-8800
  • Fax: 732-727-0955
Mailing address:
  • Phone: 732-727-8800
  • Fax: 732-727-0955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number25MB07729100
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier25MB07729100
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerLICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: