Provider Demographics
NPI:1366697617
Name:SIDDIQUI, ABRAR (MD)
Entity type:Individual
Prefix:DR
First Name:ABRAR
Middle Name:
Last Name:SIDDIQUI
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 1:17 RANDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1333
Mailing Address - Country:US
Mailing Address - Phone:716-481-0767
Mailing Address - Fax:
Practice Address - Street 1:17 RANDWOOD CT
Practice Address - Street 2:
Practice Address - City:GETZVILLE
Practice Address - State:NY
Practice Address - Zip Code:14068-1333
Practice Address - Country:US
Practice Address - Phone:716-481-0767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-28
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247404-1207Q00000X
NY247404282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03126029Medicaid
NYJ400085406Medicare PIN