Healthcare Provider Details

I. General information

NPI: 1356120562
Provider Name (Legal Business Name): HOORIA IDRIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 10/27/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 EAST SUNRISE HWY STE 201
LINDENHURST NY
11757-2539
US

IV. Provider business mailing address

2500 NESCONSET HWY BLDG 11D
STONY BROOK NY
11790-2553
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-5544
  • Fax: 631-225-9550
Mailing address:
  • Phone: 631-689-7899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF352574-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF352574
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: