Provider Demographics
NPI:1194769034
Name:FINE, MANETTE (DO)
Entity type:Individual
Prefix:DR
First Name:MANETTE
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 1:2027 QUEEN ANN RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2845
Mailing Address - Country:US
Mailing Address - Phone:856-428-8101
Mailing Address - Fax:856-428-7801
Practice Address - Street 1:2027 QUEEN ANN RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2845
Practice Address - Country:US
Practice Address - Phone:856-428-8101
Practice Address - Fax:856-428-7801
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05889000207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5599709Medicaid
NJ5599709Medicaid
NJ409550Medicare ID - Type Unspecified