Provider Demographics
NPI:1861661043
Name:AMIN, VIREN GORDHANBHAI (MD)
Entity Type:Individual
Prefix:
First Name:VIREN
Middle Name:GORDHANBHAI
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 1:34 CARRIAGE RD
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3118
Mailing Address - Country:US
Mailing Address - Phone:877-216-2916
Mailing Address - Fax:
Practice Address - Street 1:34 CARRIAGE RD
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-3118
Practice Address - Country:US
Practice Address - Phone:877-216-2916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246431207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine