Healthcare Provider Details

I. General information

NPI: 1437616075
Provider Name (Legal Business Name): PROHEALTH DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2019
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 HEMPSTEAD AVE STE A
LYNBROOK NY
11563-1640
US

IV. Provider business mailing address

50 HEMPSTEAD AVE STE A
LYNBROOK NY
11563-1640
US

V. Phone/Fax

Practice location:
  • Phone: 516-593-8808
  • Fax:
Mailing address:
  • Phone: 516-593-8808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: NEIL R KARNOFSKY
Title or Position: OWNER
Credential:
Phone: 212-969-9999