Provider Demographics
NPI:1881683167
Name:SHROFF, PRATIX KANTILAL (DDS)
Entity type:Individual
Prefix:DR
First Name:PRATIX
Middle Name:KANTILAL
Last Name:SHROFF
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 1:26309 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1354
Mailing Address - Country:US
Mailing Address - Phone:718-343-3300
Mailing Address - Fax:718-343-3324
Practice Address - Street 1:26309 UNION TPKE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11004-1354
Practice Address - Country:US
Practice Address - Phone:718-343-3300
Practice Address - Fax:718-343-3324
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0460881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01596029Medicaid