Healthcare Provider Details

I. General information

NPI: 1316332489
Provider Name (Legal Business Name): SANA IDREES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2015
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 CRITTENDEN BLVD FLAUM EYE INSTITUTE
ROCHESTER NY
14642
US

IV. Provider business mailing address

39 SYCAMORE AVE
LITTLE SILVER NJ
07739-1208
US

V. Phone/Fax

Practice location:
  • Phone: 585-273-3937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number25MA11148300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: