Provider Demographics
NPI:1457865974
Name:SARADOUNI, IDIR (NP)
Entity Type:Individual
Prefix:
First Name:IDIR
Middle Name:
Last Name:SARADOUNI
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MARINE PLZ STE 306
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-6238
Mailing Address - Country:US
Mailing Address - Phone:201-582-3000
Mailing Address - Fax:
Practice Address - Street 1:1 MARINE PLZ STE 306
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-6238
Practice Address - Country:US
Practice Address - Phone:201-582-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-20
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR18611300163W00000X
NY710574163W00000X
NY344028363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse