Si Medical Practice Associate PC

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

Legal business name

SI MEDICAL PRACTICE ASSOCIATE PC

Practice address

1147 Richmond Road
Staten Island, NY 10304

Phone

(718) 668-2340

Fax

(718) 668-2523

NPI assigned

Nov 17, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Azher Siddiqi, MDNPI 1568423093

Title

Owner President

Phone

(718) 668-2340

Specialties & licenses 1

Addresses

Other names 1

• SI Family Practice Associate Former legal business name

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Azher Siddiqi, MD

  • Internal Medicine Physician
  • Staten Island, NY
  • NPI 1568423093
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1393286400000",
    "number": "1265505036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1147 RICHMOND ROAD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "10304",
            "telephone_number": "718-668-2340",
            "fax_number": "718-668-2523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1147 RICHMOND ROAD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "10304",
            "telephone_number": "718-668-2340",
            "fax_number": "718-668-2523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SI MEDICAL PRACTICE ASSOCIATE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2014-02-25",
        "status": "A",
        "authorized_official_last_name": "SIDDIQI",
        "authorized_official_first_name": "AZHER",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "718-668-2340",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SI Family Practice Associate",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Sports Medicine (Family Medicine) Physician in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Sports Medicine (Family Medicine) Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.