Provider Demographics
NPI:1073517512
Name:FINE, STANLEY RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:RAYMOND
Last Name:FINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 THE OAKS
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1731
Mailing Address - Country:US
Mailing Address - Phone:516-484-2490
Mailing Address - Fax:516-484-2490
Practice Address - Street 1:79 THE OAKS
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1731
Practice Address - Country:US
Practice Address - Phone:516-484-2490
Practice Address - Fax:516-484-2490
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081933207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG300000260Medicare PIN
D04012Medicare UPIN