1457660094 NPI number — MOHAMMAD MOSTAFA AMIN PHYSICIAN, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457660094 NPI number — MOHAMMAD MOSTAFA AMIN PHYSICIAN, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOHAMMAD MOSTAFA AMIN PHYSICIAN, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457660094
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 655
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTEREACH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11720-0655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-974-6439
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 BELLE TERRE ROAD
Provider Second Line Business Practice Location Address:
SLEEP LAB
Provider Business Practice Location Address City Name:
PORT JEFFERSON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-974-6439
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
AMIN
Authorized Official First Name:
MOHAMMAD
Authorized Official Middle Name:
MOSTAFA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
631-974-6439

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  217753 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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