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General NPI Number Information
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NPI Number | 1710856323
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Entity Type | Individual
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Provider Name | KHIZAR AHMED SIDDIQUI PA
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Gender | Male
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Dates
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Enumeration Date | 11/03/2025
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 360 MERRICK RD STE 300
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City | LYNBROOK
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State | NY
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Zip | 11563-2526
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Country | US
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Telephone | 516-256-2017
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Fax |
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Provider Business Mailing Address
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Address Line | 565 HEMPSTEAD AVE
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City | WEST HEMPSTEAD
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State | NY
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Zip | 11552-2907
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Country | US
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Telephone | 646-436-8291
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State | NY
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