Provider Demographics
NPI:1326254418
Name:KORIN, TED
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:
Last Name:KORIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 NORTHERN BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3502
Mailing Address - Country:US
Mailing Address - Phone:516-482-5416
Mailing Address - Fax:516-482-5497
Practice Address - Street 1:2110 NORTHERN BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3502
Practice Address - Country:US
Practice Address - Phone:516-482-5416
Practice Address - Fax:516-482-5497
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY412301223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics