Provider Demographics
NPI:1760890578
Name:BARTHOLOMEW, PRINCE MICHAEL (FNP)
Entity Type:Individual
Prefix:
First Name:PRINCE
Middle Name:MICHAEL
Last Name:BARTHOLOMEW
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 KINGS HWY
Mailing Address - Street 2:4F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1860
Mailing Address - Country:US
Mailing Address - Phone:718-483-4958
Mailing Address - Fax:
Practice Address - Street 1:2807 KINGS HWY
Practice Address - Street 2:4F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1860
Practice Address - Country:US
Practice Address - Phone:718-483-4958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337635363LF0000X
NYF337635-1363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily