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NPI Code Detail

MEDICARE: DEEPAK AMIN, M.D., LLC

MEDICARE: DEEPAK AMIN, M.D., LLC
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
1174400000XSpecialist25MA08374000NJ
2207Q00000XFamily Medicine Physician25MA08048500NJ
3207Q00000XFamily Medicine Physician242719NY
4207R00000XInternal Medicine Physician189494NY
5207R00000XInternal Medicine Physician25MA06036000NJ

General Provider Information

NPI Number : 1629219670
Entity Type Code : Organization
Provider Name (Legal Business Name) : DEEPAK AMIN, M.D., LLC
Provider Business Mailing Address
First Line : 4522 KENNEDY BLVD
Second Line :
City : UNION CITY
State : NJ
Zip : 07087-8014
Country : US
Telephone Number : 201-863-1797
Fax Number : 201-863-6117
Provider Business Practice Location Address
First Line : 4522 KENNEDY BLVD
Second Line :
City : UNION CITY
State : NJ
Zip : 07087-8014
Country : US
Telephone Number : 201-863-1797
Fax Number : 201-863-6117
Authorized Official
Title or Position : OWNER
Name : DR. DEEPAK AMIN
Credential : M.D.
Telephone Number : 201-863-1797
Provider Enumeration Date : 03/19/2009
Last Update Date : 12/31/2012

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