Provider Demographics
NPI:1750540142
Name:FINE, RONNIE GUREVICH (MD)
Entity type:Individual
Prefix:
First Name:RONNIE
Middle Name:GUREVICH
Last Name:FINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RONNIE
Other - Middle Name:DINA
Other - Last Name:GUREVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:445 E 68TH ST
Mailing Address - Street 2:APT 9E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6330
Mailing Address - Country:US
Mailing Address - Phone:917-538-5971
Mailing Address - Fax:
Practice Address - Street 1:445 E 68TH ST
Practice Address - Street 2:APT 9E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6330
Practice Address - Country:US
Practice Address - Phone:917-538-5971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247400208800000X, 2088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY247400OtherLICENSE