Healthcare Provider Details

I. General information

NPI: 1225941313
Provider Name (Legal Business Name): GEORGE PRINCE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 KINGSTON ST
ROCHESTER NY
14609-7040
US

IV. Provider business mailing address

64 KINGSTON ST
ROCHESTER NY
14609-7040
US

V. Phone/Fax

Practice location:
  • Phone: 917-254-3676
  • Fax:
Mailing address:
  • Phone: 917-254-3676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: