=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316155468
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EUGENE FINE M.D., IRWIN LEVENTHAL M.D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2007
-----------------------------------------------------
Last Update Date | 02/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12 E 86TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10028-0506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-517-9555
-----------------------------------------------------
Fax | 212-737-4547
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 E 86TH ST
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10028-0506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-517-9555
-----------------------------------------------------
Fax | 212-737-4547
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | DR. EUGENE MICHAEL FINE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 212-517-9555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | 139925
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------