Provider Demographics
NPI:1295866747
Name:ELITE COMPREHENSIVE MEDICAL SERVICES PLLC
Entity Type:Organization
Organization Name:ELITE COMPREHENSIVE MEDICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KERNISANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-403-3519
Mailing Address - Street 1:345 SCHERMERHORN ST
Mailing Address - Street 2:CELINA TORRES
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1025
Mailing Address - Country:US
Mailing Address - Phone:718-403-3519
Mailing Address - Fax:
Practice Address - Street 1:629 EASTERN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-3339
Practice Address - Country:US
Practice Address - Phone:718-403-3519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical