Provider Demographics
NPI:1124311915
Name:PRINCE MEDICINE PC
Entity type:Organization
Organization Name:PRINCE MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESISENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-364-4274
Mailing Address - Street 1:80 CROSSWAYS PARK DR SUITE 200
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-1179
Mailing Address - Country:US
Mailing Address - Phone:516-802-5025
Mailing Address - Fax:516-802-5026
Practice Address - Street 1:80 CROSSWAYS PARK DR SUITE 200
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2251
Practice Address - Country:US
Practice Address - Phone:516-802-5025
Practice Address - Fax:516-802-5026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty