Healthcare Provider Details

I. General information

NPI: 1508177650
Provider Name (Legal Business Name): ENCOMPASS MEDICAL DIAGNOSTICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 07/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10114 LIBERTY AVE
OZONE PARK NY
11417-1725
US

IV. Provider business mailing address

10114 LIBERTY AVE
OZONE PARK NY
11417-1725
US

V. Phone/Fax

Practice location:
  • Phone: 516-256-2017
  • Fax: 516-256-2029
Mailing address:
  • Phone: 516-256-2017
  • Fax: 516-256-2029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number213042
License Number StateNY

VIII. Authorized Official

Name: DR. SAEED A SIDDIQUI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 516-256-2017