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General NPI Number Information
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NPI Number | 1437382231
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Entity Type | Organization
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Legal Business Name | BAYONNE MEDICAL CARE LLC
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Dates
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Enumeration Date | 08/26/2009
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Last Update Date | 07/24/2012
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Provider Practice Location Address
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Address Line | 415 AVENEL ST
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City | AVENEL
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State | NJ
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Zip | 07001-1147
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Country | US
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Telephone | 732-750-1180
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Fax | 732-750-1182
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Provider Business Mailing Address
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Address Line | 415 AVENEL ST
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City | AVENEL
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State | NJ
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Zip | 07001-1147
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Country | US
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Telephone | 732-750-1180
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Fax | 732-750-1182
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MUHAMMAD SIDDIQUE
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Credential | M.D.
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Telephone | 732-750-1180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MA 67664
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License Number State | NJ
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