Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 118387 | NY |
NPI | 1174876650 |
---|---|
Provider Name | Dr. Theodore Fink |
First Address | Carle Place, NY 11514-1095 |
Second Address | Carle Place, NY 11514-1095 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2012 |
Last Update Date | 20/10/2012 |