Provider Demographics
NPI:1194742130
Name:ROSENTHAL-CHERNYAKHOVSKY, EUGENIA (DDS)
Entity type:Individual
Prefix:
First Name:EUGENIA
Middle Name:
Last Name:ROSENTHAL-CHERNYAKHOVSKY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:EUGENIA
Other - Middle Name:
Other - Last Name:ROSENTHAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2371 OCEAN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5422
Mailing Address - Country:US
Mailing Address - Phone:718-615-1770
Mailing Address - Fax:
Practice Address - Street 1:2371 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5422
Practice Address - Country:US
Practice Address - Phone:718-615-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0355951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00684148Medicaid