Healthcare Provider Details

I. General information

NPI: 1114187952
Provider Name (Legal Business Name): SIDDIQUI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 E 14TH ST APT 2B
BROOKLYN NY
11230-4364
US

IV. Provider business mailing address

1025 E 14TH ST APT 2B
BROOKLYN NY
11230-4364
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-8128
  • Fax:
Mailing address:
  • Phone: 718-270-8128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: DR. FARRUQ M SIDDIQUI
Title or Position: CLINICAL ASSISTANT INSTRUCTOR
Credential: MD
Phone: 718-270-8128