Provider Demographics
NPI:1619978905
Name:PRINS, EDWARD R (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:R
Last Name:PRINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601
Mailing Address - Country:US
Mailing Address - Phone:201-646-0001
Mailing Address - Fax:201-646-9101
Practice Address - Street 1:5 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601
Practice Address - Country:US
Practice Address - Phone:201-646-0001
Practice Address - Fax:201-646-9101
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA042916207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0004213156OtherAETNA US HEALTHCARE
110131307OtherRAILROAD MEDICARE
0109911000OtherAMERIHEALTH
BP105OtherOXFORD HEALTH PLANS
527245OtherMEDICARE GROUP PROVIDER
80631OtherAMERIGROUP
0109911000OtherAMERIHEALTH
527245OtherMEDICARE GROUP PROVIDER