Provider Demographics
NPI:1245260231
Name:SINGH, MINI (MD)
Entity type:Individual
Prefix:
First Name:MINI
Middle Name:
Last Name:SINGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 LOUDEN AVE
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2736
Mailing Address - Country:US
Mailing Address - Phone:631-789-7225
Mailing Address - Fax:631-842-0801
Practice Address - Street 1:366 BROADWAY
Practice Address - Street 2:BUILDING #5
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2711
Practice Address - Country:US
Practice Address - Phone:631-841-4890
Practice Address - Fax:631-842-0801
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206667174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01748118Medicaid
NY51M921Medicare ID - Type Unspecified