Provider Demographics
NPI:1144790163
Name:PRINE HEALTH MEDICAL GROUP, PLLC
Entity Type:Organization
Organization Name:PRINE HEALTH MEDICAL GROUP, PLLC
Other - Org Name:PRINE PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HR/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOOHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-407-2727
Mailing Address - Street 1:1165 NORTHERN BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3048
Mailing Address - Country:US
Mailing Address - Phone:516-365-4545
Mailing Address - Fax:516-365-5532
Practice Address - Street 1:1129 NORTHERN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3022
Practice Address - Country:US
Practice Address - Phone:516-365-5570
Practice Address - Fax:516-365-5532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty