Individual provider Active NPI

Pervez A. Siddiqui, RPH

  • Pharmacist
  • Brooklyn, NY
National Provider Identifier
1396769170
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
29336 Issued in NY
Practice address
2913 Surf Ave
Brooklyn, NY 11224-1705
Phone
(718) 372-5300
Fax
(718) 372-2451
NPI assigned
Jul 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 29336 NY Primary

Addresses

Primary practice location

2913 Surf Ave
Brooklyn, NY 11224-1705

Mailing address

2913 Surf Ave
Brooklyn, NY 11224-1705
Phone (718) 372-5300

Other identifiers 1

IdentifierTypeStateIssuer
02078191MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
29336NYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Healthways Worldwide Inc Current Accepting new patients
Coney Island Pharmacy Inc Current Accepting new patients
Full Care Pharmacy Inc Past Accepting new patients

Locations

2913 Surf Ave
Brooklyn, NY 11224
Phone (718) 372-5300

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1396769170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2913 SURF AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112241705",
            "telephone_number": "718-372-5300",
            "fax_number": "718-372-2451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2913 SURF AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112241705",
            "telephone_number": "718-372-5300",
            "fax_number": "718-372-2451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDIQUI",
        "first_name": "PERVEZ",
        "middle_name": "A.",
        "name_prefix": "Mr.",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "29336",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02078191",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.