MEDICARE: DR. STANLEY RAYMOND FINE M.D.

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	207K00000X	Allergy & Immunology Physician	081933	NY

General Provider Information

NPI Number	:	1073517512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STANLEY RAYMOND FINE M.D.

Provider Business Mailing Address
First Line	:	79 THE OAKS
Second Line	:
City	:	ROSLYN
State	:	NY
Zip	:	11576-1731
Country	:	US
Telephone Number	:	516-484-2490
Fax Number	:	516-484-2490

Provider Business Practice Location Address
First Line	:	79 THE OAKS
Second Line	:
City	:	ROSLYN
State	:	NY
Zip	:	11576-1731
Country	:	US
Telephone Number	:	516-484-2490
Fax Number	:	516-484-2490

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	09/08/2014

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