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General NPI Number Information
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NPI Number | 1316591209
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Entity Type | Organization
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Legal Business Name | SIDDIQI MEDICAL P.C.
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Dates
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Enumeration Date | 07/29/2019
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Last Update Date | 07/29/2019
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Provider Practice Location Address
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Address Line | ARCHCARE AT MARY MANNING WALSH HOME 1339 YORK AVENUE
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City | NEW YORK
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State | NY
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Zip | 10021
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Country | US
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Telephone | 212-628-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 500 E 85TH ST APT 15H
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City | NEW YORK
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State | NY
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Zip | 10028-7406
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Country | US
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Telephone | 917-528-8922
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHAMAILA SIDDIQI
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Credential | MD
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Telephone | 917-528-8922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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