Healthcare Provider Details

I. General information

NPI: 1659660942
Provider Name (Legal Business Name): ASAD RIAZ SIDDIQI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 6TH ST FL 4
BROOKLYN NY
11215-3608
US

IV. Provider business mailing address

263 7TH AVE STE 5F
BROOKLYN NY
11215-3690
US

V. Phone/Fax

Practice location:
  • Phone: 646-697-0277
  • Fax: 646-967-4265
Mailing address:
  • Phone: 646-697-0277
  • Fax: 646-967-4265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number284203
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: