Provider Demographics
NPI:1598332389
Name:SIDDIQUE, ALICIA KORDA (MPH, RD, CDN)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:KORDA
Last Name:SIDDIQUE
Suffix:
Gender:F
Credentials:MPH, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 E 72ND ST APT 16C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5255
Mailing Address - Country:US
Mailing Address - Phone:650-575-5233
Mailing Address - Fax:
Practice Address - Street 1:311 E 72ND ST APT 16C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-5255
Practice Address - Country:US
Practice Address - Phone:650-575-5233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86103527133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered