Provider Demographics
NPI:1780918771
Name:COMPLETE MEDICAL PC
Entity type:Organization
Organization Name:COMPLETE MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PC
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-850-6345
Mailing Address - Street 1:13876 QUEENS BLVD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2930
Mailing Address - Country:US
Mailing Address - Phone:718-850-6345
Mailing Address - Fax:718-559-4895
Practice Address - Street 1:13876 QUEENS BLVD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-2930
Practice Address - Country:US
Practice Address - Phone:718-850-6345
Practice Address - Fax:718-559-4895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203546207QA0401X, 207QA0505X
NYN004931213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty