Healthcare Provider Details

I. General information

NPI: 1336717628
Provider Name (Legal Business Name): PROHEALTH DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 10/31/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 DOWNING DR
YORKTOWN HEIGHTS NY
10598-4413
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 Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: NATALYA KOROBEYNYK
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 516-654-4400