Healthcare Provider Details

I. General information

NPI: 1841095627
Provider Name (Legal Business Name): SOUTHSIDE NEONATAL CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BROADWAY AVE
HOLBROOK NY
11741-4917
US

IV. Provider business mailing address

800 BROADWAY AVE
HOLBROOK NY
11741-4917
US

V. Phone/Fax

Practice location:
  • Phone: 631-563-2294
  • Fax: 631-589-8946
Mailing address:
  • Phone: 631-563-2294
  • Fax: 631-589-8946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. FOAZIA SIDDIQ
Title or Position: MD
Credential: MD
Phone: 631-335-7663