Healthcare Provider Details

I. General information

NPI: 1265321400
Provider Name (Legal Business Name): ALI SADIQ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1157 FIRST COLONIAL RD STE 100
VIRGINIA BEACH VA
23454-2432
US

IV. Provider business mailing address

622 W 168TH ST
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 757-854-9564
  • Fax:
Mailing address:
  • Phone: 212-305-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401420196
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: