Healthcare Provider Details

I. General information

NPI: 1194462903
Provider Name (Legal Business Name): AHAD MUHAMMAD IDRIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2022
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 SUNRISE HWY
LINDENHURST NY
11757-2518
US

IV. Provider business mailing address

291 SUNRISE HWY
LINDENHURST NY
11757-2518
US

V. Phone/Fax

Practice location:
  • Phone: 631-991-3506
  • Fax: 631-991-3512
Mailing address:
  • Phone: 631-991-3506
  • Fax: 631-991-3512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number338597
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: