Healthcare Provider Details

I. General information

NPI: 1982785606
Provider Name (Legal Business Name): IDRO MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 CHURCH ST
FREEPORT NY
11520-3830
US

IV. Provider business mailing address

27 BALFOUR DR
BETHPAGE NY
11714-5527
US

V. Phone/Fax

Practice location:
  • Phone: 516-582-8356
  • Fax:
Mailing address:
  • Phone: 516-582-8356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MOHAMED IDRIS
Title or Position: ADMINISTRATOR
Credential: M.D.
Phone: 516-582-8356