Provider Demographics
NPI:1295321107
Name:PROHEALTH RIVERSIDE DENTAL, PLLC
Entity type:Organization
Organization Name:PROHEALTH RIVERSIDE DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RCM
Authorized Official - Prefix:MS
Authorized Official - First Name:NATALYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOROBEYNYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-654-4400
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 1:300 SYLVAN AVE FL 3
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-2525
Practice Address - Country:US
Practice Address - Phone:201-581-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROHEALTH RIVERSIDE DENTAL, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-15
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty