Table of content for
SAMIR
V
AMIN
(NPI 1821079708)
General
This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to
1821079708 NPI number —
SAMIR
V
AMIN
Organization/Personal Information
| Employer Identification Number (EIN) | : | |
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| Provider Organization Name (Legal Business Name) | : | |
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| Provider Last Name (Legal Name) | : | AMIN |
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| Provider First Name | : | SAMIR |
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| Provider Middle Name | : | V |
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| Provider Name Prefix Text | : | |
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| Provider Name Suffix Text | : | |
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| Provider Credential Text | : | |
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| Provider Gender Code | : | M |
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Provider's Other Name Information
| Provider Other Organization Name | : | |
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| Provider Other Organization Name Type Code | : | |
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| Provider Other Last Name | : | |
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| Provider Other First Name | : | |
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| Provider Other Middle Name | : | |
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| Provider Other Name Prefix Text | : | |
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| Provider Other Name Suffix Text | : | |
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| Provider Other Credential Text | : | |
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| Provider Other Last Name Type Code | : | |
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NPI Number Information
| NPI Number | : | 1821079708 |
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| Entity Type Code | : | Individual |
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| Replacement NPI | : | |
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| Last Update Date | : | 07/08/2007 |
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| NPI Deactivation Reason Code | : | |
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| NPI Deactivation Date | : | |
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| NPI Reactivation Date | : | |
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Provider's Business Mailing Address
| Provider First Line Business Mailing Address | : | 203 HERRELL RD |
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| Provider Second Line Business Mailing Address | : | |
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| Provider Business Mailing Address City Name | : | WINTER SPRINGS |
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| Provider Business Mailing Address State Name | : | FL |
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| Provider Business Mailing Address Postal Code | : | 327083635 |
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| Provider Business Mailing Address Country Code | : | US |
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| Provider Business Mailing Address Telephone Number | : | 4079232223 |
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| Provider Business Mailing Address Fax Number | : | 4076998991 |
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Provider's Practice Location Mailing Address
| Provider First Line Business Practice Location Address | : | 203 HERRELL RD |
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| Provider Second Line Business Practice Location Address | : | |
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| Provider Business Practice Location Address City Name | : | WINTER SPRINGS |
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| Provider Business Practice Location Address State Name | : | FL |
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| Provider Business Practice Location Address Postal Code | : | 327083635 |
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| Provider Business Practice Location Address Country Code | : | US |
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| Provider Business Practice Location Address Telephone Number | : | 4079232223 |
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| Provider Business Practice Location Address Fax Number | : | 4076998991 |
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| Provider Enumeration Date | : | 11/08/2005 |
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Authorized Official
| Authorized Official Last Name | : | |
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| Authorized Official First Name | : | |
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| Authorized Official Middle Name | : | |
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| Authorized Official Title or Position | : | |
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| Authorized Official Telephone Number | : | |
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Provider Taxonomy Codes
- Taxonomy code: 183500000X
, with the licence number: 4120
, registered in the state of FL
.
- Taxonomy code: 183500000X
, with the licence number: 28174
, registered in the state of FL
.
Other Provider's Identifiers (legacy, non-NPI)
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