=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932385499
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARSHAD J SIDDIQUI, INTERNAL MEDICINE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2008
-----------------------------------------------------
Last Update Date | 01/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 532 COFFEEN ST
-----------------------------------------------------
City | WATERTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13601-2421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-782-1810
-----------------------------------------------------
Fax | 315-782-1141
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 532 COFFEEN ST
-----------------------------------------------------
City | WATERTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13601-2421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-782-1810
-----------------------------------------------------
Fax | 315-782-1141
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ARSHAD JAMIL SIDDIQUI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 315-782-1810
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 125702
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------