Provider Demographics
NPI:1003903253
Name:NORTH SHORE PROSTHODONTICS OF WOODBURY
Entity Type:Organization
Organization Name:NORTH SHORE PROSTHODONTICS OF WOODBURY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:KORIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:516-364-2333
Mailing Address - Street 1:800 WOODBURY RD
Mailing Address - Street 2:STE H
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2503
Mailing Address - Country:US
Mailing Address - Phone:516-364-2333
Mailing Address - Fax:516-364-4765
Practice Address - Street 1:800 WOODBURY RD
Practice Address - Street 2:STE H
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2503
Practice Address - Country:US
Practice Address - Phone:516-364-2333
Practice Address - Fax:516-364-4765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041230122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty