Provider Demographics
NPI:1366679003
Name:FINE, AVI P (LAC)
Entity Type:Individual
Prefix:
First Name:AVI
Middle Name:P
Last Name:FINE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:204 EAGLE ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07068-1723
Mailing Address - Country:US
Mailing Address - Phone:973-228-1488
Mailing Address - Fax:973-228-4988
Practice Address - Street 1:204 EAGLE ROCK AVE
Practice Address - Street 2:
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-1723
Practice Address - Country:US
Practice Address - Phone:973-228-1488
Practice Address - Fax:973-228-4988
Is Sole Proprietor?:No
Enumeration Date:2009-06-21
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00063600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist