Individual provider Active NPI

Manette Fine, D.O.

  • Geriatric Medicine (Family Medicine) Physician
  • Cherry Hill, NJ
National Provider Identifier
1194769034
Registry record updated May 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
25MB05889000 Issued in NJ
Practice address
2027 Queen Ann Rd
Cherry Hill, NJ 08003-2845
Phone
(856) 428-8101
Fax
(856) 428-7801
NPI assigned
Jun 14, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) Physician 207QG0300X 25MB05889000 NJ Primary

Addresses

Primary practice location

2027 Queen Ann Rd
Cherry Hill, NJ 08003-2845

Mailing address

2027 Queen Ann Rd
Cherry Hill, NJ 08003-2845
Phone (856) 428-8101

Other identifiers 1

IdentifierTypeStateIssuer
5599709MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, PA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050817000268 NJ Practitioner - Family PracticePractitioner - Geriatric Medicine 3476582016 Practice locations: Cherry Hill, NJ
I20110518000312 PA Practitioner - Family Practice 3476582016 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
City of Philadelphia CurrentSince Apr 3, 2011 Accepting new patients
City of Philadelphia CurrentSince Apr 3, 2011 Accepting new patients
City of Philadelphia Current Accepting new patients

Locations

4400 Haverford Ave
#4
Philadelphia, PA 19104
Phone (215) 685-7600

1101 Market St
Fl 10
Philadelphia, PA 19107

555 S 43rd St
#3
Philadelphia, PA 19104
Phone (215) 685-7504

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211414400000",
    "number": "1194769034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2027 QUEEN ANN RD",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080032845",
            "telephone_number": "856-428-8101",
            "fax_number": "856-428-7801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2027 QUEEN ANN RD",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080032845",
            "telephone_number": "856-428-8101",
            "fax_number": "856-428-7801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FINE",
        "first_name": "MANETTE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-14",
        "last_updated": "2008-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NJ",
            "license": "25MB05889000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5599709",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cherry Hill, NJ

Sources for this page

Verify at the official NPI Registry.