Healthcare Provider Details

I. General information

NPI: 1457608812
Provider Name (Legal Business Name): SEEMA GHANSHYAM AMIN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2012
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 FRENCH ST
NEW BRUNSWICK NJ
08901-1935
US

IV. Provider business mailing address

379 CAMPUS DR FL 4
SOMERSET NJ
08873-1161
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-5699
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MB12006300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number278225
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number25MB12006300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: