Anjumon A Amin, MD
Individual provider Active NPI Pediatrics Physician · Shirley, NY
NPI 1891704011 · NPPES record last updated Dec 19, 2011
Key facts
- NPI
- 1891704011
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 196797 (NY)
- Practice address
- 550 Montauk Highway
Shirley, NY 11967 - Phone
- (631) 852-1001
- Fax
- (631) 852-1122
- NPI assigned
- Aug 5, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150327001808 | NY | Practitioner - Pediatric Medicine | 6709103922 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles (2 of 5)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sun River Health Inc. | Current |
Accepting new patients | |
| Sun River Health Inc | Current | Accepting new patients |
Locations
3360 Route 343
Amenia, NY 12501
Phone (845) 373-9006
6 Henry St
Beacon, NY 12508
Phone (845) 831-0400
1037 Main St
Peekskill, NY 10566
Phone (914) 734-8800
550 Montauk Hwy
Shirley, NY 11967
Phone (631) 852-1000
Networks
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H5989
Interoperability endpoints
- anjumon.amin@hrh.eclinicaldirectplus.com
- aamin504640@nyumc.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 196797 | NY | Yes |
Addresses
Primary practice location
550 Montauk Highway
Shirley, NY 11967
Mailing address
19 Oakdale Ave
Farmingville, NY 11738
Phone (631) 736-8589
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01770167 | Medicaid | NY | |
| 370008547 | Other | RR |
Other providers in Shirley, NY
- Aliya Ali
- Nichola Narima Ali
- Kiarra Lanetta Allen
- Isabella Alvarez
- Moshira Amer
- Anahata Ohm LLC
- Aaron Hendel Andres
- Anthony Tomasso, DO PLLC
- Philip Joachim Antz
- Karina Francesca Appel
All providers in Shirley, NY · Pediatrics Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.