Provider Demographics
NPI:1235201328
Name:ELITE MEDICAL,PC
Entity Type:Organization
Organization Name:ELITE MEDICAL,PC
Other - Org Name:SILVERBERG AND NIERMAN,MD,PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-265-0146
Mailing Address - Street 1:373 ROUTE 111
Mailing Address - Street 2:SUITE 14
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4759
Mailing Address - Country:US
Mailing Address - Phone:631-265-0146
Mailing Address - Fax:631-265-0204
Practice Address - Street 1:373 ROUTE 111
Practice Address - Street 2:SUITE 14
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4759
Practice Address - Country:US
Practice Address - Phone:631-265-0146
Practice Address - Fax:631-265-0204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCB1079OtherRR MEDICARE
NY00658957Medicaid
NYWDM191Medicare ID - Type Unspecified