Provider Demographics
NPI:1881121184
Name:AMIN, JAY (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:
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 1:2101 PARK CENTER DR STE 130
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-7611
Mailing Address - Country:US
Mailing Address - Phone:407-298-6950
Mailing Address - Fax:407-298-6951
Practice Address - Street 1:2101 PARK CENTER DR STE 130
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-7611
Practice Address - Country:US
Practice Address - Phone:407-298-6950
Practice Address - Fax:407-298-6951
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME157831208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program