Individual provider Active NPI

Abdulsamad Shahid Siddiqui

  • Orthopedic Physical Therapist
  • Bronx, NY
National Provider Identifier
1609644244
Registry record updated Dec 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
051779 Issued in NY
Practice address
1250 Waters PL Ste 1205
Bronx, NY 10461-2735
Phone
(347) 943-7422
NPI assigned
Dec 13, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X 051779 NY Primary

Addresses

Primary practice location

1250 Waters PL Ste 1205
Bronx, NY 10461-2735

Mailing address

54 E Maujer St
Valley Stream, NY 11580-4324
Phone (917) 858-2275

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231222002643 NY Practitioner - Physical Therapist in Private Practice 4981054434 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1250 Waters PL
Suite 1205
Bronx, NY 10461-2735
Phone (347) 810-7777

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Occupational & Physical Therapy, PLLC CurrentSince Dec 1, 2023 Accepting new patients
Drive Rehabilitation Physical Therapy PLLC CurrentSince Jan 12, 2026 Accepting new patients
New York Physical and Occupational Therapy Services, PLLC Orthopedic CurrentSince May 28, 2025 Accepting new patients
Professional Occupational & Physical Therapy, PLLC CurrentSince Dec 1, 2023 Accepting new patients
American Edge Physical Therapy, P.C. Orthopedic CurrentSince Feb 20, 2025 Accepting new patients
Professional Occupational & Physical Therapy, PLLC Orthopedic Current Accepting new patients
Priority One Therapy PT OT SLP PLLC CurrentSince Apr 15, 2024 Accepting new patients

Locations

1250 Waters Pl
Ste 1205
Bronx, NY 10461
Phone (347) 810-7777

2579 Ocean Ave
Fl 3
Brooklyn, NY 11229
Phone (646) 780-0925

123 Grove Ave
Cedarhurst, NY 11516
Phone (516) 374-4248

576 Broadhollow Rd
Melville, NY 11747

99 W Hawthorne Ave
Ste 210
Valley Stream, NY 11580
Phone (718) 305-1190

2142 Utopia Pkwy
Whitestone, NY 11357
Phone (718) 767-0610

Organizations & group practices 8

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": "1702425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702425600000",
    "number": "1609644244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 E MAUJER ST",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115804324",
            "telephone_number": "917-858-2275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 WATERS PL STE 1205",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104612735",
            "telephone_number": "347-943-7422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDIQUI",
        "first_name": "ABDULSAMAD",
        "middle_name": "SHAHID",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-12-13",
        "last_updated": "2023-12-13",
        "certification_date": "2023-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "NY",
            "license": "051779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.