Provider Demographics
NPI:1609990613
Name:MACK, PRINZE CHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PRINZE
Middle Name:CHAN
Last Name:MACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:257 MONMOUTH RD BLDG B STE 1
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755
Mailing Address - Country:US
Mailing Address - Phone:732-835-2020
Mailing Address - Fax:732-695-3200
Practice Address - Street 1:257 MONMOUTH RD BLDG B STE 1
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755
Practice Address - Country:US
Practice Address - Phone:732-835-2020
Practice Address - Fax:732-695-3200
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08221100207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology