Basic Information
| Provider Information | |||||||||
| NPI: | 1013645944 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMIN | ||||||||
| FirstName: | MOHAMMED | ||||||||
| MiddleName: | AMIN FADOL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3215 HULL AVE APT 2E | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104674350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9172845041 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3415 BAINBRIDGE AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104672403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187412426 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2022 | ||||||||
| LastUpdateDate: | 08/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0210X | 00000 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Nephrology |
No ID Information.