Provider Demographics
NPI:1538868336
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:OPERATIONS PROJECT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-548-8129
Mailing Address - Street 1:120 BETHPAGE RD STE 306
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-1515
Mailing Address - Country:US
Mailing Address - Phone:516-938-6000
Mailing Address - Fax:516-938-6629
Practice Address - Street 1:120 BETHPAGE RD STE 306
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-1515
Practice Address - Country:US
Practice Address - Phone:516-938-6000
Practice Address - Fax:516-938-6629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty