Healthcare Provider Details

I. General information

NPI: 1023869351
Provider Name (Legal Business Name): COMPLEX RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 SUNRISE PLAZA STORE # 2
VALLEY STREAM NY
11580
US

IV. Provider business mailing address

613 EUCLID AVE
WEST HEMPSTEAD NY
11552-3126
US

V. Phone/Fax

Practice location:
  • Phone: 718-612-5304
  • Fax:
Mailing address:
  • Phone: 718-612-5304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID KATZ
Title or Position: CEO
Credential:
Phone: 718-612-5304