Healthcare Provider Details

I. General information

NPI: 1306945852
Provider Name (Legal Business Name): JAGRUTI AMIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 E BUTLER PIKE
AMBLER PA
19002-2310
US

IV. Provider business mailing address

722 E BUTLER PIKE
AMBLER PA
19002-2310
US

V. Phone/Fax

Practice location:
  • Phone: 610-524-1552
  • Fax: 610-524-6039
Mailing address:
  • Phone: 610-524-1552
  • Fax: 610-524-6039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD054746L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0016556970003
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier830401
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBLUE SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: