Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 34.013801 | OH |
NPI | 1073938460 |
---|---|
Provider Name | Ahmed Siddiqi |
First Address | Manasquan, NJ 08736-1444 |
Second Address | Manasquan, NJ 08736-1444 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2014 |
Last Update Date | 11/10/2021 |