NPIMap

Organization Active NPI

Prohealth Dental PLLC

  • General Practice Dentistry
  • Huntington, NY
National Provider Identifier
1477010148
Registry record updated Feb 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
PROHEALTH DENTAL PLLC
Practice address
35B Gerard St
Huntington, NY 11743-2704
Phone
(631) 812-5000
NPI assigned
Feb 28, 2019
Last updated
Feb 21, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
PROHEALTH DENTAL PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 21, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Natalya Korobeynyk
Title
RCM
Phone
(516) 654-4400

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Dentist 122300000X NU
General Practice Dentistry 1223G0001X NU Primary
Pediatric Dentistry 1223P0221X NU

Addresses

Primary practice location

35B Gerard St
Huntington, NY 11743-2704

Mailing address

3333 New Hyde Park Rd Ste 310
New Hyde Park, NY 11042-1205
Phone (516) 654-4400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190522000562 NY DME Supplier - Oral Surgery - Dentist 7911261847 Practice locations: Huntington, NY

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Prohealth Dental PLLC11 organizations share this tax ID, including this one
Part of
Prohealth Dental PLLC

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Locations

35 Gerard St
#B
Huntington, NY 11743
Phone (631) 812-5000

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1551312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676937600000",
    "number": "1477010148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 NEW HYDE PARK RD STE 310",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110421205",
            "telephone_number": "516-654-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35B GERARD ST",
            "city": "HUNTINGTON",
            "state": "NY",
            "postal_code": "117432704",
            "telephone_number": "631-812-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROHEALTH DENTAL PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROHEALTH DENTAL PLLC",
        "enumeration_date": "2019-02-28",
        "last_updated": "2023-02-21",
        "certification_date": "2023-02-21",
        "status": "A",
        "authorized_official_last_name": "KOROBEYNYK",
        "authorized_official_first_name": "NATALYA",
        "authorized_official_title_or_position": "RCM",
        "authorized_official_telephone_number": "516-654-4400"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntington, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.