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General NPI Number Information
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NPI Number | 1861431942
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Entity Type | Individual
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Provider Name | TARIQ S. SIDDIQI M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 01/14/2013
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Provider Practice Location Address
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Address Line | 1 SHEPPARD ROAD SUITE 900
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City | VOORHEES
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State | NJ
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Zip | 08043-4520
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Country | US
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Telephone | 856-751-6600
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Fax | 856-751-5556
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Provider Business Mailing Address
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Address Line | 70 BORTONS RD
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City | MARLTON
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State | NJ
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Zip | 08053-5403
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Country | US
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Telephone | 856-768-5506
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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 | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 25MA03599600
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License Number State | NJ
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