Provider Demographics
NPI:1154646081
Name:FINE, BRIAN I
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:I
Last Name:FINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4106
Mailing Address - Country:US
Mailing Address - Phone:718-768-3010
Mailing Address - Fax:718-768-0156
Practice Address - Street 1:803 8TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4106
Practice Address - Country:US
Practice Address - Phone:718-768-3010
Practice Address - Fax:718-768-0156
Is Sole Proprietor?:No
Enumeration Date:2010-04-03
Last Update Date:2010-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035383183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist