Provider Demographics
NPI:1144020132
Name:PRINE HEALTH MEDICAL GROUP, PLLC
Entity type:Organization
Organization Name:PRINE HEALTH MEDICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:ELLIOT
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-407-2727
Mailing Address - Street 1:370 OLD COUNTRY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-1702
Mailing Address - Country:US
Mailing Address - Phone:516-407-2727
Mailing Address - Fax:516-387-9797
Practice Address - Street 1:1800 ROCKAWAY AVE STE 212
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1677
Practice Address - Country:US
Practice Address - Phone:516-407-2727
Practice Address - Fax:516-387-9797
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRINE HEALTH MEDICAL GROUP, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site