Provider Demographics
NPI:1497490429
Name:COMPLEXION MEDICAL PLLC
Entity Type:Organization
Organization Name:COMPLEXION MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GLODNY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-698-6864
Mailing Address - Street 1:580 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7313
Mailing Address - Country:US
Mailing Address - Phone:212-752-3692
Mailing Address - Fax:
Practice Address - Street 1:580 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7313
Practice Address - Country:US
Practice Address - Phone:212-752-3692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty