Healthcare Provider Details

I. General information

NPI: 1720071731
Provider Name (Legal Business Name): GIRISH S AMIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 JACK MARTIN BLVD STE 201
BRICK NJ
08724-7737
US

IV. Provider business mailing address

525 JACK MARTIN BLVD STE 201
BRICK NJ
08724-7737
US

V. Phone/Fax

Practice location:
  • Phone: 732-840-8880
  • Fax: 732-840-3939
Mailing address:
  • Phone: 732-840-8880
  • Fax: 732-840-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number25MA06311400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number25MA06311400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: