Individual
DR. IMTIAZUDDIN M SIDDIQUI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
510 HAMBURG TURNPIKE, SUITE E106, WAYNE, NJ 07470
(973) 904-3161
(973) 904-3168
Mailing address
252 WASHINGTON VALLEY ROAD, RANDOLPH, NJ 07869
(973) 904-3161
(973) 904-3163
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MA041078
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7833008
—
NJ
Enumeration date
10/30/2006
Last updated
03/27/2013
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