Healthcare Provider Details

I. General information

NPI: 1013980630
Provider Name (Legal Business Name): STEVEN L PRINCE D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 07/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 MARINA RD
ISLAND PARK NY
11558-1007
US

IV. Provider business mailing address

78 MARINA RD
ISLAND PARK NY
11558-1007
US

V. Phone/Fax

Practice location:
  • Phone: 516-432-1332
  • Fax:
Mailing address:
  • Phone: 516-432-1332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN004623
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: