Provider Demographics
NPI:1669271912
Name:FRU, PRINCELY MALONGE
Entity type:Individual
Prefix:
First Name:PRINCELY
Middle Name:MALONGE
Last Name:FRU
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9963 GOOD LUCK RD APT 101
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3274
Mailing Address - Country:US
Mailing Address - Phone:301-291-6513
Mailing Address - Fax:
Practice Address - Street 1:9963 GOOD LUCK RD APT 101
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3274
Practice Address - Country:US
Practice Address - Phone:301-291-6513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
MD172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker