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General NPI Number Information
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NPI Number | 1457660094
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Entity Type | Organization
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Legal Business Name | MOHAMMAD MOSTAFA AMIN PHYSICIAN, PLLC
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Dates
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Enumeration Date | 09/30/2010
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Last Update Date | 09/30/2010
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Provider Practice Location Address
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Address Line | 200 BELLE TERRE ROAD SLEEP LAB
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City | PORT JEFFERSON
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State | NY
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Zip | 11777
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Country | US
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Telephone | 631-974-6439
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 655
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City | CENTEREACH
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State | NY
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Zip | 11720-0655
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Country | US
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Telephone | 631-974-6439
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MOHAMMAD MOSTAFA AMIN I
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Credential |
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Telephone | 631-974-6439
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 217753
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License Number State | NY
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