Provider Demographics
NPI:1023446747
Name:FINK, JESSE (PT)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:FINK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11039 DUGWAY RD
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14735-8610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 MINARD ST
Practice Address - Street 2:
Practice Address - City:FILLMORE
Practice Address - State:NY
Practice Address - Zip Code:14735-9803
Practice Address - Country:US
Practice Address - Phone:585-567-2232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62036733225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY62036733OtherSTATE OF NY