Healthcare Provider Details

I. General information

NPI: 1568714665
Provider Name (Legal Business Name): JUSTIN LLOYD FINK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2012
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 NATURES LN
MILLER PLACE NY
11764-3137
US

IV. Provider business mailing address

148 NATURES LN
MILLER PLACE NY
11764-3137
US

V. Phone/Fax

Practice location:
  • Phone: 631-636-6888
  • Fax: 631-209-5129
Mailing address:
  • Phone: 631-636-6888
  • Fax: 631-209-5129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number016184
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: