MEDICARE: PROHEALTH DENTAL PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	122300000X	Dentist
2	1223P0221X	Pediatric Dentistry
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1477010148
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	:	35B GERARD ST
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-2704
Country	:	US
Telephone Number	:	631-812-5000
Fax Number	:

Authorized Official
Title or Position	:	RCM
Name	:	NATALYA KOROBEYNYK
Credential	:
Telephone Number	:	516-654-4400

Provider Enumeration Date	:	02/28/2019
Last Update Date	:	02/21/2023

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