Provider Demographics
NPI:1548617525
Name:AMIN, MADHAT S I
Entity Type:Individual
Prefix:MR
First Name:MADHAT
Middle Name:S
Last Name:AMIN
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 BROADWAY OFC
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-3034
Mailing Address - Country:US
Mailing Address - Phone:201-471-2221
Mailing Address - Fax:201-471-7799
Practice Address - Street 1:914 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002
Practice Address - Country:US
Practice Address - Phone:201-471-2221
Practice Address - Fax:201-471-7799
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-19
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246X00000X, 332B00000X
NJ332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist Cardiovascular