Provider Demographics
NPI:1396129912
Name:SIDDIQI, MADHEEA (MD)
Entity type:Individual
Prefix:
First Name:MADHEEA
Middle Name:
Last Name:SIDDIQI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108-136 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:APT 1706B
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-5348
Mailing Address - Country:US
Mailing Address - Phone:201-968-7261
Mailing Address - Fax:
Practice Address - Street 1:185 S ORANGE AVE # 972-6015
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2757
Practice Address - Country:US
Practice Address - Phone:973-972-6015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ320-33-21-135208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics