Provider Demographics
NPI:1083471692
Name:EQUINOX ELITE LLC
Entity Type:Organization
Organization Name:EQUINOX ELITE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FASIUR
Authorized Official - Middle Name:RAHMAN
Authorized Official - Last Name:SYED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-722-0304
Mailing Address - Street 1:6134 N CAMPBELL AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4161
Mailing Address - Country:US
Mailing Address - Phone:708-722-0304
Mailing Address - Fax:
Practice Address - Street 1:6134 N CAMPBELL AVE APT 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4161
Practice Address - Country:US
Practice Address - Phone:708-722-0304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies