Basic Information
Provider Information
NPI: 1689692261
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FINK
FirstName: JAMES
MiddleName: A.
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 615 CHESTNUT ST
Address2: 14TH FLOOR
City: PHILADELPHIA
State: PA
PostalCode: 191064404
CountryCode: US
TelephoneNumber: 2159551175
FaxNumber: 2159552420
Practice Location
Address1: 833 CHESTNUT ST
Address2: SUITE 701
City: PHILADELPHIA
State: PA
PostalCode: 191074414
CountryCode: US
TelephoneNumber: 2159556180
FaxNumber: 2159556410
Other Information
ProviderEnumerationDate: 07/18/2006
LastUpdateDate: 11/02/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD425085PAY Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
004493805NJ MEDICAID


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