Provider Demographics
NPI:1457660094
Name:MOHAMMAD MOSTAFA AMIN PHYSICIAN, PLLC
Entity Type:Organization
Organization Name:MOHAMMAD MOSTAFA AMIN PHYSICIAN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:MOSTAFA
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:631-974-6439
Mailing Address - Street 1:PO BOX 655
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-0655
Mailing Address - Country:US
Mailing Address - Phone:631-974-6439
Mailing Address - Fax:
Practice Address - Street 1:200 BELLE TERRE ROAD
Practice Address - Street 2:SLEEP LAB
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777
Practice Address - Country:US
Practice Address - Phone:631-974-6439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217753207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty