Provider Demographics
NPI:1912058371
Name:MOHAMMED H IDRIS, MD
Entity Type:Organization
Organization Name:MOHAMMED H IDRIS, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:H
Authorized Official - Last Name:IDRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-582-8356
Mailing Address - Street 1:27 BALFOUR DR
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5527
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:393 SUNRISE HWY
Practice Address - Street 2:SUITE 7
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-5909
Practice Address - Country:US
Practice Address - Phone:516-582-8356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty