Healthcare Provider Details

I. General information

NPI: 1558553263
Provider Name (Legal Business Name): SAMINA SIDDIQUI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 10/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24302 NORTHEN BLVD
DOUGLASTON NY
11362-1199
US

IV. Provider business mailing address

17 LINDEN ST
GREAT NECK NY
11021-3841
US

V. Phone/Fax

Practice location:
  • Phone: 718-423-6200
  • Fax: 718-423-9762
Mailing address:
  • Phone: 281-804-0457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberP9960
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: