Provider Demographics
NPI:1477655868
Name:FINE, ROBERT M (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:FINE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:9 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12839-1840
Mailing Address - Country:US
Mailing Address - Phone:518-747-2372
Mailing Address - Fax:518-747-2543
Practice Address - Street 1:9 CLARK ST
Practice Address - Street 2:
Practice Address - City:HUDSON FALLS
Practice Address - State:NY
Practice Address - Zip Code:12839-1840
Practice Address - Country:US
Practice Address - Phone:518-747-2372
Practice Address - Fax:518-747-2543
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003042-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT26495Medicare UPIN
NY37785BMedicare ID - Type Unspecified