Healthcare Provider Details

I. General information

NPI: 1558822890
Provider Name (Legal Business Name): AYUSH AMIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 MEETING HOUSE LN
SOUTHAMPTON NY
11968-5009
US

IV. Provider business mailing address

4820 SW 48TH AVE UNIT 305
OCALA FL
34474-6303
US

V. Phone/Fax

Practice location:
  • Phone: 631-726-8200
  • Fax: 631-726-0396
Mailing address:
  • Phone: 732-766-3531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number103680
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME171781
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number103680
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME171781
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: