Provider Demographics
NPI:1124099288
Name:FINE, SHARI (DO)
Entity type:Individual
Prefix:DR
First Name:SHARI
Middle Name:
Last Name:FINE
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 1:25 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-3027
Mailing Address - Country:US
Mailing Address - Phone:201-656-3139
Mailing Address - Fax:201-656-9270
Practice Address - Street 1:324 PALISADE AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-1718
Practice Address - Country:US
Practice Address - Phone:201-656-3139
Practice Address - Fax:201-656-9270
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB48303207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8202702Medicaid
NJSH712695Medicare ID - Type Unspecified
NJ8202702Medicaid