Provider Demographics
NPI:1720071731
Name:AMIN, GIRISH S (MD)
Entity Type:Individual
Prefix:
First Name:GIRISH
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 1:1608 ROUTE 88 W
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3009
Mailing Address - Country:US
Mailing Address - Phone:732-840-8880
Mailing Address - Fax:732-840-3939
Practice Address - Street 1:1608 ROUTE 88 W
Practice Address - Street 2:SUIRE 250
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3009
Practice Address - Country:US
Practice Address - Phone:732-840-8880
Practice Address - Fax:732-840-3939
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06311400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ010063114NJ01OtherANTHEM
NJ3819175002OtherCIGNA
NJ6861504Medicaid
NJ2337188OtherAETNA
NJ59699OtherLOCAL 825
NJ830006947OtherMEDICARE RAILROAD
NJ19668OtherMASTCARE
NJ117039OtherCHN
NJ2505650OtherGHI
NJ809231OtherEMPIRE HEALTHCARE
NJ59699OtherLOCAL 825
NJ2337188OtherAETNA