Provider Demographics
NPI:1407092620
Name:AMIN, HETAL T (DO)
Entity Type:Individual
Prefix:DR
First Name:HETAL
Middle Name:T
Last Name:AMIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MURRAY ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4311
Mailing Address - Country:US
Mailing Address - Phone:518-743-1010
Mailing Address - Fax:518-743-1018
Practice Address - Street 1:7 MURRAY ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4311
Practice Address - Country:US
Practice Address - Phone:518-743-1010
Practice Address - Fax:518-743-1018
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220388-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine