Provider Demographics
NPI:1588095343
Name:VOROB, ALEX
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:VOROB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 NEPTUNE AVE
Mailing Address - Street 2:14-O
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-4301
Mailing Address - Country:US
Mailing Address - Phone:718-714-5084
Mailing Address - Fax:
Practice Address - Street 1:460 NEPTUNE AVE
Practice Address - Street 2:14-O
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-4301
Practice Address - Country:US
Practice Address - Phone:718-714-5084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY38071122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist