Individual ProviderMutasim IdrissStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address1561 Long Pond Rd Ste 206, Rochester, NY 14626-4135(585) 368-4800(585) 723-7746PECOS EnrollmentBased on the most recent information from CMS, provider Mutasim Idriss does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1760168157Provider TypeIndividualFull NameIdriss, MutasimCredentialMDGenderMaleSole ProprietorNoEnumeration Date6/22/2023Last Updated6/22/2023Contact InformationPractice LocationPractice Address1561 Long Pond Rd Ste 206, Rochester, NY 14626-4135Phone(585) 368-4800Fax(585) 368-4815Mailing LocationMailing Address1555 Long Pond Rd, Rochester, NY 14626-4164Phone(585) 723-7746Fax(585) 723-7834Provider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer