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General NPI Number Information
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NPI Number | 1316332489
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Entity Type | Individual
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Provider Name | SANA IDREES MD
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Gender | Female
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Dates
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Enumeration Date | 04/05/2015
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Last Update Date | 07/07/2021
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Provider Practice Location Address
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Address Line | 210 CRITTENDEN BLVD FLAUM EYE INSTITUTE
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City | ROCHESTER
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State | NY
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Zip | 14642
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Country | US
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Telephone | 585-273-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 39 SYCAMORE AVE
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City | LITTLE SILVER
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State | NJ
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Zip | 07739-1208
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | 25MA11148300
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License Number State | NJ
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