Provider Demographics
NPI:1679186308
Name:AMIN, PRIYA P (DC)
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:P
Last Name:AMIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 COLTS GAIT RD
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-5721
Mailing Address - Country:US
Mailing Address - Phone:856-236-9664
Mailing Address - Fax:
Practice Address - Street 1:1307 WHITE HORSE ROAD
Practice Address - Street 2:BUILDING B SUITE 200
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043
Practice Address - Country:US
Practice Address - Phone:856-783-6789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00771300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor