Provider Demographics
NPI:1326584939
Name:PRINCE, LUCIEN (MT)
Entity Type:Individual
Prefix:DR
First Name:LUCIEN
Middle Name:
Last Name:PRINCE
Suffix:
Gender:M
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 W MERRICK RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5101
Mailing Address - Country:US
Mailing Address - Phone:516-986-5429
Mailing Address - Fax:516-825-0112
Practice Address - Street 1:550 W MERRICK RD
Practice Address - Street 2:SUITE 2
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5101
Practice Address - Country:US
Practice Address - Phone:516-986-5429
Practice Address - Fax:516-825-0112
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0165601246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist