Provider Demographics
NPI:1255701959
Name:PROHEALTH DENTAL PLLC
Entity type:Organization
Organization Name:PROHEALTH DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RCM
Authorized Official - Prefix:
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:516-467-8192
Practice Address - Street 1:1 PRO HEALTH PLZ
Practice Address - Street 2:SUITE 115
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-467-8191
Practice Address - Fax:516-467-8192
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROHEALTH DENTAL PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-07
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X
NY0555311223E0200X
NY0428571223G0001X
NY0578381223G0001X
NY0533821223P0221X
NY0554001223P0221X
NY0376231223P0700X
NY0438341223P0700X
NY0367531223S0112X
NY0498461223X0400X
NY0379891223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty