Provider Demographics
NPI:1003373903
Name:PROHEALTH DENTAL PLLC
Entity Type:Organization
Organization Name:PROHEALTH DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RCM
Authorized Official - Prefix:
Authorized Official - First Name:NATALYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOROBEYNYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-654-4400
Mailing Address - Street 1:3333 NEW HYDE PARK RD STE 310
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1205
Mailing Address - Country:US
Mailing Address - Phone:516-654-4400
Mailing Address - Fax:
Practice Address - Street 1:5011 VERNON BLVD
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101
Practice Address - Country:US
Practice Address - Phone:718-650-5566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROHEALTH DENTAL PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-27
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty