Healthcare Provider Details

I. General information

NPI: 1972677763
Provider Name (Legal Business Name): OMAR SIDDIQI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 5TH ST SADDLE BROOK
SADDLE BROOK NJ
07663-6216
US

IV. Provider business mailing address

468 FOREST AVE
PARAMUS NJ
07652
US

V. Phone/Fax

Practice location:
  • Phone: 973-478-1616
  • Fax: 973-478-1732
Mailing address:
  • Phone: 973-715-0214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0531371
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: