1659372829 NPI number — DR. DEEPAK K AMIN MD

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 1659372829 NPI number — DR. DEEPAK K AMIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMIN
Provider First Name:
DEEPAK
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1659372829
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4522 KENNEDY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNION CITY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07087-2707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-863-1797
Provider Business Mailing Address Fax Number:
201-863-6117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4522 KENNEDY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07087-2707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-863-1797
Provider Business Practice Location Address Fax Number:
201-863-6117
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MA06036000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 189494 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: D06424500 . This is a "NJ CDS LICENSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 01391726 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4273397 . This is a "ECFMG NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 189494 . This is a "NY LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6149806 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: MA06036000 . This is a "NJ LICENSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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