MEDICARE: MR. DIPAK P AMIN RPH

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	183500000X	Pharmacist	35881	NY
2	183500000X	Pharmacist	28R101852200	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35881	OTHER	NY	NEW YORK STATE PHARMACIST
2	28R101852200	OTHER	NJ	NEW JERSEY PHARMACIST

General Provider Information

NPI Number	:	1992037659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DIPAK P AMIN RPH

Provider Business Mailing Address
First Line	:	1280 ST.NICHOLAS AVE
Second Line	:
City	:	NEW YORK CITY
State	:	NY
Zip	:	10033-4502
Country	:	US
Telephone Number	:	212-928-8082
Fax Number	:	212-928-2088

Provider Business Practice Location Address
First Line	:	1280 ST.NICHOLAS AVE
Second Line	:
City	:	NEW YORK CITY
State	:	NY
Zip	:	10033-4502
Country	:	US
Telephone Number	:	212-928-8082
Fax Number	:	212-928-2088

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

Provider Enumeration Date	:	02/05/2010
Last Update Date	:	02/05/2010

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