Provider Demographics
NPI:1013980630
Name:PRINCE, STEVEN L (DPM)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:PRINCE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 MARINA RD
Mailing Address - Street 2:
Mailing Address - City:ISLAND PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11558-1007
Mailing Address - Country:US
Mailing Address - Phone:516-432-1332
Mailing Address - Fax:
Practice Address - Street 1:78 MARINA RD
Practice Address - Street 2:
Practice Address - City:ISLAND PARK
Practice Address - State:NY
Practice Address - Zip Code:11558-1007
Practice Address - Country:US
Practice Address - Phone:516-432-1332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004623213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01138430Medicaid
NY01138430Medicaid