Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 68050 | CT |
Y | 111NI0900X | Internist | 68050 | CT |
N | 208200000X | Surgeon | 68050 | CT |
N | 208600000X | Surgeon | 68050 | CT |
NPI | 1003312018 |
---|---|
Provider Name | Jahanzaib Idrees |
First Address | Milford, CT 06460-4633 |
Second Address | Milford, CT 06460-4633 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2018 |
Last Update Date | 05/10/2021 |