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General NPI Number Information
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NPI Number | 1902335524
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Entity Type | Individual
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Provider Name | AZAM SIDDIQUI
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Gender | Male
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Dates
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Enumeration Date | 06/07/2017
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 65 W JIMMIE LEEDS RD
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City | POMONA
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State | NJ
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Zip | 08240-9102
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Country | US
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Telephone | 609-404-3817
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Fax |
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Provider Business Mailing Address
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Address Line | 3511 SCHOONER RDG
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City | ALPHARETTA
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State | GA
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Zip | 30005-4259
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Country | US
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Telephone | 678-756-6503
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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 | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 25MA01234500
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License Number State | NJ
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