=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043439680
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FINECARE MEDICAL MANAGEMENT, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2007
-----------------------------------------------------
Last Update Date | 08/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5907 71ST AVE
-----------------------------------------------------
City | RIDGEWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11385-5655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-628-9800
-----------------------------------------------------
Fax | 718-628-1810
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5907 71ST AVE
-----------------------------------------------------
City | RIDGEWOOD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11385-5655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-628-9800
-----------------------------------------------------
Fax | 718-628-1810
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES
-----------------------------------------------------
Name | MR. IRFAN S CHAUDHRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-628-9800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 7977
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------