Provider Demographics
NPI:1255332946
Name:FINE, STEVEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:FINE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 WILLOWBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-1640
Mailing Address - Country:US
Mailing Address - Phone:856-751-3441
Mailing Address - Fax:
Practice Address - Street 1:406 WILLOWBROOK WAY
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1640
Practice Address - Country:US
Practice Address - Phone:856-751-3441
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01448213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJFI432591Medicare ID - Type Unspecified
NJT44939Medicare UPIN