Provider Demographics
NPI:1316155468
Name:EUGENE FINE M.D., IRWIN LEVENTHAL M.D.
Entity type:Organization
Organization Name:EUGENE FINE M.D., IRWIN LEVENTHAL M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-517-9555
Mailing Address - Street 1:12 E 86TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0506
Mailing Address - Country:US
Mailing Address - Phone:212-517-9555
Mailing Address - Fax:212-737-4547
Practice Address - Street 1:12 E 86TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0506
Practice Address - Country:US
Practice Address - Phone:212-517-9555
Practice Address - Fax:212-737-4547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139925208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00899674Medicaid
NY00899674Medicaid
NY068A541Medicare ID - Type Unspecified
NYCO9934Medicare UPIN
NY044D471Medicare ID - Type Unspecified