Provider Demographics
NPI:1174895429
Name:MIDWOOD GENERAL AND PHYSICAL MEDICINE, P.C.
Entity type:Organization
Organization Name:MIDWOOD GENERAL AND PHYSICAL MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARRUQ
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-725-8283
Mailing Address - Street 1:62 NEWBERRY AVE
Mailing Address - Street 2:1C
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4144
Mailing Address - Country:US
Mailing Address - Phone:646-725-8283
Mailing Address - Fax:
Practice Address - Street 1:1122 CONEY ISLAND AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2345
Practice Address - Country:US
Practice Address - Phone:718-725-8341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260559208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty