Healthcare Provider Details

I. General information

NPI: 1295321107
Provider Name (Legal Business Name): PROHEALTH RIVERSIDE DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SYLVAN AVE FL 3
ENGLEWOOD CLIFFS NJ
07632-2525
US

IV. Provider business mailing address

3333 NEW HYDE PARK RD STE 310
NEW HYDE PARK NY
11042-1205
US

V. Phone/Fax

Practice location:
  • Phone: 201-581-6300
  • 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: MS. NATALYA KOROBEYNYK
Title or Position: RCM
Credential:
Phone: 516-654-4400