Provider Demographics
NPI:1336798909
Name:PROHEALTH RIVERSIDE DENTAL, LLC
Entity Type:Organization
Organization Name:PROHEALTH RIVERSIDE DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KARNOFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-531-5500
Mailing Address - Street 1:1 PRO HEALTH PLZ STE 300
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 ROUTE 17 FL 12
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-2557
Practice Address - Country:US
Practice Address - Phone:516-654-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-06
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty