Provider Demographics
NPI:1043321722
Name:LEV AMINOV, INTERNAL MEDICINE, PC
Entity Type:Organization
Organization Name:LEV AMINOV, INTERNAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEV
Authorized Official - Middle Name:
Authorized Official - Last Name:AMINOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-275-6968
Mailing Address - Street 1:9851 64TH AVE
Mailing Address - Street 2:STE 1G
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2546
Mailing Address - Country:US
Mailing Address - Phone:718-275-6968
Mailing Address - Fax:718-275-4506
Practice Address - Street 1:9851 64TH AVE
Practice Address - Street 2:STE 1G
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2546
Practice Address - Country:US
Practice Address - Phone:718-275-6968
Practice Address - Fax:718-275-4506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199857207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01582498Medicaid
NY01827AMedicare ID - Type Unspecified
G14027Medicare UPIN