Provider Demographics
NPI:1770543068
Name:KORPACZ FINK, MARY J (DO)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:KORPACZ FINK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 ISLIP AVE
Mailing Address - Street 2:STE 22
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-3225
Mailing Address - Country:US
Mailing Address - Phone:631-277-1616
Mailing Address - Fax:631-277-1804
Practice Address - Street 1:152 ISLIP AVE
Practice Address - Street 2:STE 22
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3225
Practice Address - Country:US
Practice Address - Phone:631-277-1616
Practice Address - Fax:631-277-1804
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY480582Medicare ID - Type Unspecified
NYG38676Medicare UPIN