Provider Demographics
NPI:1750452744
Name:AMIN, PRAKASH P (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAKASH
Middle Name:P
Last Name:AMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2211 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-2605
Mailing Address - Country:US
Mailing Address - Phone:609-587-2255
Mailing Address - Fax:609-587-7255
Practice Address - Street 1:2211 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-2605
Practice Address - Country:US
Practice Address - Phone:609-587-2255
Practice Address - Fax:609-587-7255
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA518492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJB43334Medicare UPIN
NJ536567Medicare ID - Type Unspecified