MEDICARE: MAHENDRA AMIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	155444	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235128711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHENDRA AMIN M.D.

Provider Business Mailing Address
First Line	:	8902 SPRINGFIELD BLVD
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11427
Country	:	US
Telephone Number	:	718-776-4444
Fax Number	:	718-776-8536

Provider Business Practice Location Address
First Line	:	8902 SPRINGFIELD BLVD
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11427-2514
Country	:	US
Telephone Number	:	718-776-4444
Fax Number	:	718-776-8536

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	03/14/2014

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