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General NPI Number Information
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NPI Number | 1043450018
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Entity Type | Organization
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Legal Business Name | PRINZE MACK, LLC
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Dates
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Enumeration Date | 03/03/2009
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Last Update Date | 01/29/2019
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Provider Practice Location Address
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Address Line | 257 MONMOUTH RD BLDG B STE 1
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City | OAKHURST
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State | NJ
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Zip | 07755
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Country | US
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Telephone | 732-835-2020
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Fax | 732-695-3200
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Provider Business Mailing Address
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Address Line | 257 MONMOUTH RD BLDG B STE 1
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City | OAKHURST
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State | NJ
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Zip | 07755
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Country | US
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Telephone | 732-835-2020
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Fax | 732-695-3200
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Authorized Official
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Title or Position | OWNER
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Name | DR. PRINZE CHAN MACK
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Credential | M.D.
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Telephone | 201-532-3342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 25MA08221100
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License Number State | NJ
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