Provider Demographics
NPI:1346326105
Name:FINK, MITCHELL JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:JAMES
Last Name:FINK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 CHALFORD LN
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-3402
Mailing Address - Country:US
Mailing Address - Phone:609-871-9666
Mailing Address - Fax:609-871-9669
Practice Address - Street 1:42 CHALFORD LN
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-3402
Practice Address - Country:US
Practice Address - Phone:609-871-9666
Practice Address - Fax:609-871-9669
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00284300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2360403Medicaid
193576NX2Medicare ID - Type Unspecified
NJ2360403Medicaid