Provider Demographics
NPI:1588108377
Name:FINEFROCK, CYNTHIA ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANNE
Last Name:FINEFROCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-2416
Mailing Address - Country:US
Mailing Address - Phone:480-577-6619
Mailing Address - Fax:
Practice Address - Street 1:130 E 18TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2416
Practice Address - Country:US
Practice Address - Phone:480-577-6619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2017-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020377363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical