Provider Demographics
NPI:1164293312
Name:SIDDIQUI, FAIZAN NASIR (PA-C)
Entity type:Individual
Prefix:
First Name:FAIZAN
Middle Name:NASIR
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ROUTE 35 STE 201
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-2609
Mailing Address - Country:US
Mailing Address - Phone:732-653-1790
Mailing Address - Fax:
Practice Address - Street 1:1000 ROUTE 35 STE 201
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-2609
Practice Address - Country:US
Practice Address - Phone:732-653-1790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant