Basic Information
| Provider Information | |||||||||
| NPI: | 1558553263 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIDDIQUI | ||||||||
| FirstName: | SAMINA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17 LINDEN ST | ||||||||
| Address2: | |||||||||
| City: | GREAT NECK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110213841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2818040457 | ||||||||
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| Practice Location | |||||||||
| Address1: | 24302 NORTHEN BLVD | ||||||||
| Address2: | |||||||||
| City: | DOUGLASTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113621199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184236200 | ||||||||
| FaxNumber: | 7184239762 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2007 | ||||||||
| LastUpdateDate: | 10/26/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | P9960 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.