MEDICARE: FINECARE MEDICAL MANAGEMENT, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	7977	NY

General Provider Information

NPI Number	:	1043439680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FINECARE MEDICAL MANAGEMENT, INC

Provider Business Mailing Address
First Line	:	5907 71ST AVE
Second Line	:
City	:	RIDGEWOOD
State	:	NY
Zip	:	11385-5655
Country	:	US
Telephone Number	:	718-628-9800
Fax Number	:	718-628-1810

Provider Business Practice Location Address
First Line	:	5907 71ST AVE
Second Line	:
City	:	RIDGEWOOD
State	:	NY
Zip	:	11385-5655
Country	:	US
Telephone Number	:	718-628-9800
Fax Number	:	718-628-1810

Authorized Official
Title or Position	:	PRES
Name	:	MR. IRFAN S CHAUDHRY
Credential	:
Telephone Number	:	718-628-9800

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	08/26/2008

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