Organization Name: | PRINCE MEDICINE PC |
NPI Number: | 1124311915 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | HENRY K PRINCE (PRESISENT) |
Mailing Address: | 12 Platinum Ct Medford |
State: | NY US |
Postal Code: | 117632251 |
Phone Number: | 5163644274 |
Fax Number: | |
NPI Enumeration Date: | 05/26/2011 |
NPI Last Update Date: | 06/19/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |