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General NPI Number Information
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NPI Number | 1538213889
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Entity Type | Individual
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Provider Name | RICHARD JEFFFREY KOBAK D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 590 JERICHO TURNPIKE
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City | SYOSSET
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State | NY
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Zip | 11791
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Country | US
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Telephone | 516-433-2211
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Fax | 516-681-2562
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Provider Business Mailing Address
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Address Line | 590 JERICHO TURNPIKE
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City | SYOSSET
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State | NY
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Zip | 11791
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Country | US
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Telephone | 516-433-2211
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Fax | 516-681-2562
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 042775
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 042775
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License Number State | NY
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