Individual
DR. JOHN A PRUDENTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5645 MAIN ST, FLUSHING, NY 11355-5045
(718) 670-2000
Mailing address
6535 170TH ST, FRESH MEADOWS, NY 11365-1949
(631) 680-8138
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
308128
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/14/2017
Last updated
05/22/2023
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