=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538039722
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROLINK CREDENTIALING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2025
-----------------------------------------------------
Last Update Date | 11/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 84 BA MAR DR
-----------------------------------------------------
City | STONY POINT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10980-2028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-499-5362
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 228 E ROUTE 59
-----------------------------------------------------
City | NANUET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10954-2905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-499-5302
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PROLINK CREDENTIALING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 845-499-5320
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------