Healthcare Provider Details

I. General information

NPI: 1164146056
Provider Name (Legal Business Name): ARTHUR J PRICE II MSN CRNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 E MAIN ST
ENDICOTT NY
13760-4925
US

IV. Provider business mailing address

145 TAYLOR AVE
NICHOLS NY
13812-3245
US

V. Phone/Fax

Practice location:
  • Phone: 607-785-2460
  • Fax:
Mailing address:
  • Phone: 570-899-4264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP025929
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number526384-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: