Provider Demographics
NPI:1861649055
Name:AMINI, ANOUSHIRAVAN (MD)
Entity Type:Individual
Prefix:
First Name:ANOUSHIRAVAN
Middle Name:
Last Name:AMINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3400 BAINBRIDGE AVE # 4311
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2404
Mailing Address - Country:US
Mailing Address - Phone:718-920-8584
Mailing Address - Fax:718-231-9811
Practice Address - Street 1:3400 BAINBRIDGE AVE # 4311
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2404
Practice Address - Country:US
Practice Address - Phone:718-920-8584
Practice Address - Fax:718-231-9811
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2992192086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery