NPIMap

Individual provider Active NPI

Ahmed Moid Siddiqui, MD

  • Student in an Organized Health Care Education/Training Program
  • Brooklyn, NY
National Provider Identifier
1902254576
Registry record updated May 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
240 Willoughby St
Maynard Building - Suite 19C
Brooklyn, NY 11201-5465
Phone
(718) 250-6120
NPI assigned
May 24, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X BP10070894 TX
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

240 Willoughby St
Maynard Building - Suite 19C
Brooklyn, NY 11201-5465

Mailing address

240 Willoughby St
Maynard Building - Suite 19C
Brooklyn, NY 11201-5465
Phone (718) 250-6120

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230426001175 NY Practitioner - Endocrinology 9739426297 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Endocrinology
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Icahn School of Medicine at Mount SinaiGroup PAC ID 8224282926, 317 clinicians

Practice addresses (Care Compare)

7901 Broadway
Elmhurst, NY 11373-1329
Phone (718) 334-4952

Hospital & facility affiliations

  • Elmhurst Hospital Center Hospital, Elmhurst, NY, CCN 330128

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai Current Accepting new patients
Icahn School of Medicine at Mount Sinai Current Accepting new patients
Icahn School of Medicine at Mount Sinai CurrentSince Jan 12, 2023 Accepting new patients
Icahn School of Medicine at Mount Sinai Current Accepting new patients
Icahn School of Medicine at Mount Sinai Current Accepting new patients
Icahn School of Medicine at Mount Sinai Current Accepting new patients
Icahn School of Medicine at Mount Sinai Current Accepting new patients
Icahn School of Medicine at Mount Sinai Endocrinology, Diabetes & Metabolism CurrentSince Jan 12, 2023 Accepting new patients
Icahn School of Medicine at Mount Sinai Current Accepting new patients
Icahn School of Medicine at Mount Sinai Current Accepting new patients
Icahn School of Medicine at Mount Sinai Current Accepting new patients
Icahn School of Medicine at Mount Sinai Current Accepting new patients

Locations

7901 Broadway
Rm A119
Elmhurst, NY 11373
Phone (718) 334-3915

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722

Organizations & group practices 12

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1464048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588896000000",
    "number": "1902254576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 WILLOUGHBY ST",
            "address_2": "MAYNARD BUILDING - SUITE 19C",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112015465",
            "telephone_number": "718-250-6120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 WILLOUGHBY ST",
            "address_2": "MAYNARD BUILDING - SUITE 19C",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112015465",
            "telephone_number": "718-250-6120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDIQUI",
        "first_name": "AHMED",
        "middle_name": "MOID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-24",
        "last_updated": "2020-05-08",
        "certification_date": "2020-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "TX",
            "license": "BP10070894",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.