Provider Demographics
NPI:1407070857
Name:KORNGOLD, HARVEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:
Last Name:KORNGOLD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 DAVIE ST
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-5906
Mailing Address - Country:US
Mailing Address - Phone:516-333-0366
Mailing Address - Fax:516-333-0366
Practice Address - Street 1:2533 STEINWAY ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3701
Practice Address - Country:US
Practice Address - Phone:718-204-4777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30761122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist