Healthcare Provider Details

I. General information

NPI: 1457865974
Provider Name (Legal Business Name): IDIR SARADOUNI NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2017
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3807 BERGENLINE AVE
UNION CITY NJ
07087-4860
US

IV. Provider business mailing address

3807 BERGENLINE AVE
UNION CITY NJ
07087-4860
US

V. Phone/Fax

Practice location:
  • Phone: 201-691-4828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number344028
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00935500
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number710574
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: