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NPI Code Detail

MEDICARE: PROHEALTH DENTAL PLLC

MEDICARE: PROHEALTH DENTAL PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223E0200XEndodontics
21223P0221XPediatric Dentistry
31223P0300XPeriodontics
4332B00000XDurable Medical Equipment & Medical Supplies
51223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1003373903
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROHEALTH DENTAL PLLC
Provider Business Mailing Address
First Line : 3333 NEW HYDE PARK RD STE 310
Second Line :
City : NEW HYDE PARK
State : NY
Zip : 11042-1205
Country : US
Telephone Number : 516-654-4400
Fax Number :
Provider Business Practice Location Address
First Line : 5011 VERNON BLVD
Second Line :
City : LONG ISLAND CITY
State : NY
Zip : 11101
Country : US
Telephone Number : 718-650-5566
Fax Number :
Authorized Official
Title or Position : RCM
Name : NATALYA KOROBEYNYK
Credential :
Telephone Number : 516-654-4400
Provider Enumeration Date : 02/27/2019
Last Update Date : 02/21/2023

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