Provider Demographics
NPI:1003312018
Name:IDREES, JAHANZAIB (MD, MPH)
Entity Type:Individual
Prefix:
First Name:JAHANZAIB
Middle Name:
Last Name:IDREES
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:J
Other - Last Name:IDREES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:2044 BRIDGEPORT AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4633
Mailing Address - Country:US
Mailing Address - Phone:216-688-9320
Mailing Address - Fax:
Practice Address - Street 1:2044 BRIDGEPORT AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4633
Practice Address - Country:US
Practice Address - Phone:216-688-9320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT68050208600000X, 208D00000X, 207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine