Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 104454 | NY |
Y | 208600000X | Surgeon | 104454 | NY |
N | 2086S0102X | Surgical Critical Care | 104454 | NY |
NPI | 1306892583 |
---|---|
Provider Name | Simon D. Fink |
First Address | Flushing, NY 11355-5045 |
Second Address | Flushing, NY 11355-5045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 26/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00181599 | (05) | NY |
E39143 | (02) | NY |