Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | 231868 | NY |
Y | 208D00000X | General Practice Physician | 231868 | NY |
NPI | 1467897058 |
---|---|
Provider Name | Komal Amin |
First Address | Commack, NY 11725-3414 |
Second Address | Commack, NY 11725-3414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2013 |
Last Update Date | 03/04/2019 |