Provider Demographics
NPI:1861431942
Name:SIDDIQI, TARIQ S (MD)
Entity type:Individual
Prefix:DR
First Name:TARIQ
Middle Name:S
Last Name:SIDDIQI
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 1:70 BORTONS RD
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-5403
Mailing Address - Country:US
Mailing Address - Phone:856-768-5506
Mailing Address - Fax:
Practice Address - Street 1:1 SHEPPARD ROAD
Practice Address - Street 2:SUITE 900
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4520
Practice Address - Country:US
Practice Address - Phone:856-751-6600
Practice Address - Fax:856-751-5556
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03599600207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ222833407OtherHMO & PPO ID
NJ1972103Medicaid
NJDO6847Medicare UPIN
NJ158806Medicare ID - Type Unspecified