Provider Demographics
NPI:1285969980
Name:SIDDIQUI, IQBAL H (DO)
Entity type:Individual
Prefix:
First Name:IQBAL
Middle Name:H
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 TOWER DR
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-3319
Mailing Address - Country:US
Mailing Address - Phone:973-428-4773
Mailing Address - Fax:
Practice Address - Street 1:9 TOWER DR
Practice Address - Street 2:
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936-3319
Practice Address - Country:US
Practice Address - Phone:973-428-4773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB86729207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0219371Medicaid
NJ171646SN3Medicare PIN
NJ171646UWXMedicare PIN
NJ171646UXKMedicare PIN
NJ171646UWYMedicare PIN