1144020132 NPI number — PRINE HEALTH MEDICAL GROUP, PLLC

Table of content: (NPI 1144020132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144020132 NPI number — PRINE HEALTH MEDICAL GROUP, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRINE HEALTH MEDICAL GROUP, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144020132
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
370 OLD COUNTRY RD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDEN CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11530-1702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-407-2727
Provider Business Mailing Address Fax Number:
516-387-9797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 ROCKAWAY AVE STE 212
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEWLETT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11557-1677
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-407-2727
Provider Business Practice Location Address Fax Number:
516-387-9797
Provider Enumeration Date:
03/18/2025

Additional Information

Authorized Official

Authorized Official Last Name:
PRINCE
Authorized Official First Name:
SIMON
Authorized Official Middle Name:
ELLIOT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
516-407-2727

Provider Taxonomy Codes

  • Taxonomy code: 332900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com