Healthcare Provider Details

I. General information

NPI: 1639761646
Provider Name (Legal Business Name): CAREMOUNT DENTAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 LEXINGTON AVE
MOUNT KISCO NY
10549-4309
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: 516-654-4400
  • Fax:
Mailing address:
  • Phone: 516-654-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 3
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