Provider Demographics
NPI:1922116268
Name:AMIN, JASHVANT S (MD)
Entity Type:Individual
Prefix:
First Name:JASHVANT
Middle Name:S
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 1:355 HENRY STREET
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050
Mailing Address - Country:US
Mailing Address - Phone:973-672-0352
Mailing Address - Fax:973-672-3393
Practice Address - Street 1:355 HENRY STREET
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050
Practice Address - Country:US
Practice Address - Phone:973-672-0352
Practice Address - Fax:973-672-3393
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02769900207R00000X, 207RG0300X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2858908Medicaid
NJAM12168Medicare ID - Type Unspecified
C52480Medicare UPIN