Healthcare Provider Details

I. General information

NPI: 1811963960
Provider Name (Legal Business Name): JEFFREY SCOTT FINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 1ST AVE BELLEVUE HOSPITAL - ECI
NEW YORK NY
10016-9196
US

IV. Provider business mailing address

107 MONTCLAIR AVE
MONTCLAIR NJ
07042-4128
US

V. Phone/Fax

Practice location:
  • Phone: 212-562-6346
  • Fax:
Mailing address:
  • Phone: 973-746-2970
  • Fax: 973-746-2970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number173479
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: