Provider Demographics
NPI:1023503505
Name:AMIN, BUSHRA (MD)
Entity type:Individual
Prefix:DR
First Name:BUSHRA
Middle Name:
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 1:3860 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2422
Mailing Address - Country:US
Mailing Address - Phone:718-881-0100
Mailing Address - Fax:929-285-4650
Practice Address - Street 1:3860 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2422
Practice Address - Country:US
Practice Address - Phone:718-881-0100
Practice Address - Fax:929-285-4650
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY311083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program