Provider Demographics
NPI:1053408740
Name:AMIN, ACHALA HASMUKH (MD)
Entity type:Individual
Prefix:DR
First Name:ACHALA
Middle Name:HASMUKH
Last Name:AMIN
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 1:42 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4511
Mailing Address - Country:US
Mailing Address - Phone:607-772-8020
Mailing Address - Fax:607-348-0079
Practice Address - Street 1:42 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4511
Practice Address - Country:US
Practice Address - Phone:607-772-8020
Practice Address - Fax:607-348-0079
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156586207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00840515Medicaid
B82872Medicare UPIN
NY50424BMedicare ID - Type Unspecified