Healthcare Provider Details

I. General information

NPI: 1659869394
Provider Name (Legal Business Name): NOAM DAVID FINE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2018
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 BOSTON POST RD
LARCHMONT NY
10538-3902
US

IV. Provider business mailing address

2649 STRANG BLVD STE 304
YORKTOWN HEIGHTS NY
10598-2938
US

V. Phone/Fax

Practice location:
  • Phone: 929-440-9400
  • Fax:
Mailing address:
  • Phone: 646-745-6369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number345396
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD27204
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: