Provider Demographics
NPI:1073131512
Name:PROHEALTH DENTAL PLLC
Entity Type:Organization
Organization Name:PROHEALTH DENTAL PLLC
Other - Org Name:ASTORIA ORTHODONTIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:R
Authorized Official - Last Name:KARNOFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-531-5500
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 1:2318 31ST ST STE 320
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2765
Practice Address - Country:US
Practice Address - Phone:718-274-1515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROHEALTH DENTAL PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-10
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05942434Medicaid