Provider Demographics
NPI:1902254576
Name:SIDDIQUI, AHMED MOID (MD)
Entity Type:Individual
Prefix:
First Name:AHMED
Middle Name:MOID
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 WILLOUGHBY ST
Mailing Address - Street 2:MAYNARD BUILDING - SUITE 19C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5465
Mailing Address - Country:US
Mailing Address - Phone:718-250-6120
Mailing Address - Fax:
Practice Address - Street 1:240 WILLOUGHBY ST
Practice Address - Street 2:MAYNARD BUILDING - SUITE 19C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5465
Practice Address - Country:US
Practice Address - Phone:718-250-6120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10070894207RE0101X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism