Healthcare Provider Details

I. General information

NPI: 1881496982
Provider Name (Legal Business Name): MAHJABEEN YEASMIN SIDDIQI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 BROADWAY FL 2
PATERSON NJ
07501-2100
US

IV. Provider business mailing address

370 BROADWAY FL 2
PATERSON NJ
07501-2100
US

V. Phone/Fax

Practice location:
  • Phone: 973-429-6888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI03155800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: