Provider Demographics
NPI:1477639292
Name:PRINCE, ANDREW M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:M
Last Name:PRINCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:680 KINDERKAMACK RD STE 103
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1600
Mailing Address - Country:US
Mailing Address - Phone:201-265-9040
Mailing Address - Fax:201-523-9784
Practice Address - Street 1:680 KINDERKAMACK RD STE 103
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1600
Practice Address - Country:US
Practice Address - Phone:201-265-9040
Practice Address - Fax:201-523-9784
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2023-05-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY154005207W00000X
NJMA68525207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00905922Medicaid
NYA63067Medicare UPIN
NYA63067Medicare UPIN