Provider Demographics
NPI:1457392763
Name:SQUARE CARE MEDICAL GROUP, LLP
Entity Type:Organization
Organization Name:SQUARE CARE MEDICAL GROUP, LLP
Other - Org Name:WOMEN'S HEALTH PROFESSIONALS, LLP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-496-3900
Mailing Address - Street 1:900 MERCHANTS CONCOURSE STE 216
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-5114
Mailing Address - Country:US
Mailing Address - Phone:516-758-2556
Mailing Address - Fax:
Practice Address - Street 1:40 CROSSWAYS PARK DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2036
Practice Address - Country:US
Practice Address - Phone:516-496-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207VM0101X
NY135297207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWDW571Medicare PIN
NY07575Medicare PIN