Provider Demographics
NPI:1487654323
Name:PRISCO, DOUGLAS LOUIS SR (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:LOUIS
Last Name:PRISCO
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3003 NEW HYDE PARK RD
Mailing Address - Street 2:STE. 201
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1214
Mailing Address - Country:US
Mailing Address - Phone:516-488-2880
Mailing Address - Fax:516-488-2022
Practice Address - Street 1:3003 NEW HYDE PARK RD
Practice Address - Street 2:STE. 201
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1214
Practice Address - Country:US
Practice Address - Phone:516-488-2880
Practice Address - Fax:516-488-2022
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126645207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDS049OtherOXFORD
NY03411OtherGHI MEDICARE
NY343741OtherEMPIRE BC/BS
NY00479974Medicaid
NY6006070OtherCIGNA
NY126645OtherHIP
NY343741OtherEMPIRE BC/BS
NY6006070OtherCIGNA