Individual provider · NPI-1

Dr. Khawaja Asim Siddique, MD

Family Medicine · Glen Cove, NY

NPI number1750636635

StatusActive

Last updated in NPPESMay 24, 2025

Details

NPI: 1750636635
Entity type: Individual (NPI-1)
Name: Dr. Khawaja Asim Siddique
Credential: MD
Sex: Male
Sole proprietor: No
Enumeration date: Jul 17, 2012
Certification date: May 24, 2025
Last updated: May 24, 2025

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
207Q00000X	Family Medicine	280349	NY	Yes
202D00000X	Integrative Medicine	280349	NY
2083B0002X	Preventive Medicine, Obesity Medicine	280349	NY

Practice location

235 Forest Ave
Glen Cove, NY 11542-2034

Phone 516-671-7770 · Fax 516-671-6372

Mailing address

235 Forest Ave
Glen Cove, NY 11542-2034

Phone 516-671-7770 · Fax 516-671-6372

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