Provider Demographics
NPI:1235788142
Name:PRINSEN CORP
Entity Type:Organization
Organization Name:PRINSEN CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:PRINSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO, PHD
Authorized Official - Phone:585-415-9332
Mailing Address - Street 1:689 HOLLANDALE RD
Mailing Address - Street 2:
Mailing Address - City:LA VERGNE
Mailing Address - State:TN
Mailing Address - Zip Code:37086-2039
Mailing Address - Country:US
Mailing Address - Phone:978-415-9332
Mailing Address - Fax:615-280-2442
Practice Address - Street 1:689 HOLLANDALE RD
Practice Address - Street 2:
Practice Address - City:LA VERGNE
Practice Address - State:TN
Practice Address - Zip Code:37086-2039
Practice Address - Country:US
Practice Address - Phone:978-415-9332
Practice Address - Fax:615-280-2442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service