Healthcare Provider Details

I. General information

NPI: 1073151114
Provider Name (Legal Business Name): PROHEALTH RIVERSIDE DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 RIVER RD STE 104
EDGEWATER NJ
07020-1002
US

IV. Provider business mailing address

1 PRO HEALTH PLZ STE 300
NEW HYDE PARK NY
11042
US

V. Phone/Fax

Practice location:
  • Phone: 201-941-0088
  • Fax:
Mailing address:
  • Phone: 516-654-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: NEIL KARNOFSKY
Title or Position: MANAGING PARTNER
Credential: DDS
Phone: 516-654-4400