Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 25MB05889000 | NJ |
NPI | 1194769034 |
---|---|
Provider Name | Dr. Manette Fine |
First Address | Cherry Hill, NJ 08003-2845 |
Second Address | Cherry Hill, NJ 08003-2845 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 22/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5599709 | (05) | NJ |
F44553 | (02) | NJ |