Provider Demographics
NPI:1356120562
Name:IDRIS, HOORIA (FNP)
Entity type:Individual
Prefix:
First Name:HOORIA
Middle Name:
Last Name:IDRIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 NESCONSET HWY BLDG 11D
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2553
Mailing Address - Country:US
Mailing Address - Phone:631-689-7899
Mailing Address - Fax:
Practice Address - Street 1:150 EAST SUNRISE HWY
Practice Address - Street 2:STE 201
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-2539
Practice Address - Country:US
Practice Address - Phone:631-444-5544
Practice Address - Fax:631-225-9550
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF352574-01363LF0000X
NYF352574363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily