Healthcare Provider Details

I. General information

NPI: 1821079237
Provider Name (Legal Business Name): JAMES FINE M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 05/04/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 SEGUINE AVE
STATEN ISLAND NY
10309-3932
US

IV. Provider business mailing address

7 LIVINGSTON AVE
NEW BRUNSWICK NJ
08901-4083
US

V. Phone/Fax

Practice location:
  • Phone: 207-660-5253
  • Fax:
Mailing address:
  • Phone: 207-660-5253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number014268
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number139360
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: