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NPI Code Detail

MEDICARE: DR. JOHN LEO PRUE M.D.

MEDICARE: DR. JOHN LEO PRUE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician124179NY

General Provider Information

NPI Number : 1780742643
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN LEO PRUE M.D.
Provider Business Mailing Address
First Line : 78 CROMWELL AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10304-3912
Country : US
Telephone Number : 718-987-9175
Fax Number : 718-987-1678
Provider Business Practice Location Address
First Line : 78 CROMWELL AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10304-3912
Country : US
Telephone Number : 718-987-9175
Fax Number : 718-987-1678
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2006
Last Update Date : 01/10/2017

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Directions to “ DR. JOHN LEO PRUE M.D.” Practice Location

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