MEDICARE: MICHAEL FINA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	040964	NY

General Provider Information

NPI Number	:	1033652128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL FINA

Provider Business Mailing Address
First Line	:	1351 FOREST AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10302-2049
Country	:	US
Telephone Number	:	718-844-5350
Fax Number	:	718-390-0067

Provider Business Practice Location Address
First Line	:	1243 WOODROW RD
Second Line	:	UNIT 323
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-1725
Country	:	US
Telephone Number	:	718-966-0111
Fax Number	:	718-390-0067

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2016
Last Update Date	:	11/22/2016

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