Healthcare Provider Details

I. General information

NPI: 1659485548
Provider Name (Legal Business Name): OPRX #11558, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 LONG BEACH RD
ISLAND PARK NY
11558-1509
US

IV. Provider business mailing address

333 LONG BEACH RD
ISLAND PARK NY
11558-1509
US

V. Phone/Fax

Practice location:
  • Phone: 516-431-1991
  • Fax: 516-431-1496
Mailing address:
  • Phone: 516-431-1991
  • Fax: 516-431-1496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number013869
License Number StateNY

VIII. Authorized Official

Name: SARIT ROY
Title or Position: MANAGING MEMBER
Credential:
Phone: 516-876-0737