Provider Demographics
NPI:1235128711
Name:AMIN, MAHENDRA (MD)
Entity Type:Individual
Prefix:
First Name:MAHENDRA
Middle Name:
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 1:8902 SPRINGFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11427
Mailing Address - Country:US
Mailing Address - Phone:718-776-4444
Mailing Address - Fax:718-776-8536
Practice Address - Street 1:8902 SPRINGFIELD BLVD
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-2514
Practice Address - Country:US
Practice Address - Phone:718-776-4444
Practice Address - Fax:718-776-8536
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155444207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00832435Medicaid
NY82085Medicare ID - Type Unspecified
NY00832435Medicaid