Basic Information
Provider Information | |||||||||
NPI: | 1811943087 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | AMIN | ||||||||
FirstName: | HIRAL | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 67 PROSPECT AVE | ||||||||
Address2: | SUITE 210 | ||||||||
City: | HUDSON | ||||||||
State: | NY | ||||||||
PostalCode: | 125342907 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5188282566 | ||||||||
FaxNumber: | 5186973403 | ||||||||
Practice Location | |||||||||
Address1: | 67 PROSPECT AVE | ||||||||
Address2: | SUITE 210 | ||||||||
City: | HUDSON | ||||||||
State: | NY | ||||||||
PostalCode: | 125342907 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5188282566 | ||||||||
FaxNumber: | 5186973403 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/26/2006 | ||||||||
LastUpdateDate: | 05/02/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 1-172481 | NY | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207UN0901X | 1-172481 | NY | N |   | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology |
ID Information
ID | Type | State | Issuer | Description | 2503158 | 01 |   | GHI PPO | OTHER | 1209565 | 01 |   | UNITED HEALTHCARE | OTHER | 040426007321 | 01 |   | FIDELIS | OTHER | 13531 | 01 |   | GHI HMO | OTHER | 000406799001 | 01 |   | BS OF NENY | OTHER | 01210622 | 05 | NY |   | MEDICAID | 113531 | 01 |   | WELLCARE | OTHER | 922432 | 01 |   | MVP | OTHER | 10000037 | 01 |   | CDPHP | OTHER | 717022 | 01 |   | BC/BS | OTHER | P902328 | 01 |   | OXFORD | OTHER |