Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | N004623 | NY |
NPI | 1013980630 |
---|---|
Provider Name | Steven L Prince |
First Address | Island Park, NY 11558-1007 |
Second Address | Island Park, NY 11558-1007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 22/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01138430 | (05) | NY |
T86779 | (02) |