MEDICARE: BETH AMY FINE MA

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	235Z00000X	Speech-Language Pathologist	96	NY

General Provider Information

NPI Number	:	1669426045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH AMY FINE MA

Provider Business Mailing Address
First Line	:	120 E 56TH ST
Second Line	:	SUITE 920
City	:	NEW YORK
State	:	NY
Zip	:	10022-3607
Country	:	US
Telephone Number	:	212-888-3696
Fax Number	:	212-888-3687

Provider Business Practice Location Address
First Line	:	120 E 56TH ST
Second Line	:	SUITE 920
City	:	NEW YORK
State	:	NY
Zip	:	10022-3607
Country	:	US
Telephone Number	:	212-888-3696
Fax Number	:	212-888-3687

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

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	07/08/2007

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Directions to “ BETH AMY FINE MA” Practice Location

Language	Start Address	Practice Location

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