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NPI Code Detail

MEDICARE: DR. KHAWAJA ASIM SIDDIQUE MD

MEDICARE: DR. KHAWAJA ASIM SIDDIQUE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1202D00000XIntegrative Medicine Physician280349NY
22083B0002XObesity Medicine (Preventive Medicine) Physician280349NY
3207Q00000XFamily Medicine Physician280349NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750636635
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KHAWAJA ASIM SIDDIQUE MD
Provider Business Mailing Address
First Line : 235 FOREST AVE
Second Line :
City : GLEN COVE
State : NY
Zip : 11542-2034
Country : US
Telephone Number : 516-671-7770
Fax Number : 516-671-6372
Provider Business Practice Location Address
First Line : 235 FOREST AVE
Second Line :
City : GLEN COVE
State : NY
Zip : 11542-2034
Country : US
Telephone Number : 516-671-7770
Fax Number : 516-671-6372
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2012
Last Update Date : 05/24/2025

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