Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 081933 | NY |
NPI | 1073517512 |
---|---|
Provider Name | Dr. Stanley Raymond Fine |
First Address | Roslyn, NY 11576-1731 |
Second Address | Roslyn, NY 11576-1731 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 08/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D04012 | (02) |