Basic Information
| Provider Information | |||||||||
| NPI: | 1316155468 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EUGENE FINE M.D., IRWIN LEVENTHAL M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12 E 86TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100280506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125179555 | ||||||||
| FaxNumber: | 2127374547 | ||||||||
| Practice Location | |||||||||
| Address1: | 12 E 86TH ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100280506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125179555 | ||||||||
| FaxNumber: | 2127374547 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 02/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | FINE | ||||||||
| AuthorizedOfficialFirstName: | EUGENE | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 2125179555 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 139925 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 00899674 | 05 | NY | MEDICAID |