Provider Demographics
NPI:1659372829
Name:AMIN, DEEPAK K (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPAK
Middle Name:K
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 1:4522 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-2707
Mailing Address - Country:US
Mailing Address - Phone:201-863-1797
Mailing Address - Fax:201-863-6117
Practice Address - Street 1:4522 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-2707
Practice Address - Country:US
Practice Address - Phone:201-863-1797
Practice Address - Fax:201-863-6117
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA06036000207R00000X
NY189494207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD06424500OtherNJ CDS LICENSE
NY01391726Medicaid
4273397OtherECFMG NUMBER
NY189494OtherNY LICENSE
NJ6149806Medicaid
NJMA06036000OtherNJ LICENSE
NJ6149806Medicaid
NJMA06036000OtherNJ LICENSE
NJMA06036000OtherNJ LICENSE
NJ6149806Medicaid
NY98K352Medicare PIN
NY01391726Medicaid