Provider Demographics
NPI:1710089743
Name:KORIK, LEONID (DMD)
Entity Type:Individual
Prefix:
First Name:LEONID
Middle Name:
Last Name:KORIK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OCEANA DR WEST
Mailing Address - Street 2:APT 4-I
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235
Mailing Address - Country:US
Mailing Address - Phone:347-312-6155
Mailing Address - Fax:
Practice Address - Street 1:1130 BRIGHTON BEACH AVE
Practice Address - Street 2:APT 1-CC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235
Practice Address - Country:US
Practice Address - Phone:917-332-9400
Practice Address - Fax:917-332-8990
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034597122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00409485Medicaid