Healthcare Provider Details

I. General information

NPI: 1992551469
Provider Name (Legal Business Name): AMMAR SIDDIQUI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 HILLCREST VLG E APT A4
SCHENECTADY NY
12309-3822
US

IV. Provider business mailing address

15 HILLCREST VLG E APT A4
SCHENECTADY NY
12309-3822
US

V. Phone/Fax

Practice location:
  • Phone: 510-314-5992
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberOT023981
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number346837
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: