MEDICARE: MARY J KORPACZ FINK D.O.

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	207Q00000X	Family Medicine Physician	202371	NY

General Provider Information

NPI Number	:	1770543068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY J KORPACZ FINK D.O.

Provider Business Mailing Address
First Line	:	152 ISLIP AVE
Second Line	:	STE 22
City	:	ISLIP
State	:	NY
Zip	:	11751-3225
Country	:	US
Telephone Number	:	631-277-1616
Fax Number	:	631-277-1804

Provider Business Practice Location Address
First Line	:	152 ISLIP AVE
Second Line	:	STE 22
City	:	ISLIP
State	:	NY
Zip	:	11751-3225
Country	:	US
Telephone Number	:	631-277-1616
Fax Number	:	631-277-1804

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	09/01/2010

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