Basic Information
| Provider Information | |||||||||
| NPI: | 1780682351 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FINE | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 777 S CLINTON AVE | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146201448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852794800 | ||||||||
| FaxNumber: | 5854428319 | ||||||||
| Practice Location | |||||||||
| Address1: | 777 S CLINTON AVE | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146201448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852794800 | ||||||||
| FaxNumber: | 5854428319 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2005 | ||||||||
| LastUpdateDate: | 06/26/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 191818 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207R00000X | 191818 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01709237 | 05 | NY | MEDICAID |