Provider Demographics
NPI:1053668400
Name:ELITE WOMAN'S MEDICAL HEALTH CARE
Entity Type:Organization
Organization Name:ELITE WOMAN'S MEDICAL HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAZEM
Authorized Official - Middle Name:
Authorized Official - Last Name:QALLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-791-8551
Mailing Address - Street 1:20 2ND ST
Mailing Address - Street 2:APT 1603
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3075
Mailing Address - Country:US
Mailing Address - Phone:201-656-0806
Mailing Address - Fax:
Practice Address - Street 1:110 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-2787
Practice Address - Country:US
Practice Address - Phone:718-852-5810
Practice Address - Fax:718-802-1223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-04
Last Update Date:2012-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253610207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty