Individual
AUSTIN D PRINCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
601 PORTION RD STE 2, LAKE RONKONKOMA, NY 11779-4585
(631) 648-9708
Mailing address
601 PORTION RD STE 2, LAKE RONKONKOMA, NY 11779-4585
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
NY
Other
Enumeration date
09/14/2021
Last updated
09/14/2021
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