Provider Demographics
NPI:1144236019
Name:PRUDEN, STEPHEN JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOSEPH
Last Name:PRUDEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 BRYANT AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1137
Mailing Address - Country:US
Mailing Address - Phone:516-626-3965
Mailing Address - Fax:516-625-7701
Practice Address - Street 1:55 BRYANT AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1137
Practice Address - Country:US
Practice Address - Phone:516-626-3965
Practice Address - Fax:516-625-7701
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX4234-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX4234-1OtherSTATE LICENSE
NYX4234-1OtherSTATE LICENSE