Provider Demographics
NPI:1538039722
Name:PROLINK CREDENTIALING
Entity type:Organization
Organization Name:PROLINK CREDENTIALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PROLINK
Authorized Official - Middle Name:
Authorized Official - Last Name:CREDENTIALING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-499-5320
Mailing Address - Street 1:228 E ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2905
Mailing Address - Country:US
Mailing Address - Phone:845-499-5302
Mailing Address - Fax:
Practice Address - Street 1:84 BA MAR DR
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980-2028
Practice Address - Country:US
Practice Address - Phone:845-499-5362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-11
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty