Provider Demographics
NPI:1568714665
Name:FINK, JUSTIN LLOYD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:LLOYD
Last Name:FINK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 NATURES LN
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-3137
Mailing Address - Country:US
Mailing Address - Phone:631-636-6888
Mailing Address - Fax:631-209-5129
Practice Address - Street 1:148 NATURES LN
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-3137
Practice Address - Country:US
Practice Address - Phone:631-636-6888
Practice Address - Fax:631-209-5129
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363AM0700X
NY016184363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical