Provider Demographics
NPI:1003911645
Name:AMIN, KALPESH S (MD)
Entity Type:Individual
Prefix:DR
First Name:KALPESH
Middle Name:S
Last Name:AMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TURF LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2713
Mailing Address - Country:US
Mailing Address - Phone:718-497-8419
Mailing Address - Fax:718-386-3522
Practice Address - Street 1:6911 FOREST AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-4457
Practice Address - Country:US
Practice Address - Phone:718-497-8419
Practice Address - Fax:718-386-3522
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193962207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01644311Medicaid
NY02087Medicare ID - Type Unspecified
NY01644311Medicaid