Provider Demographics
NPI:1497482988
Name:ELITE SPINE AND WELLNESS, LLC
Entity Type:Organization
Organization Name:ELITE SPINE AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAHANGIR
Authorized Official - Middle Name:
Authorized Official - Last Name:ASGHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-506-8507
Mailing Address - Street 1:499 NW 70TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-7578
Mailing Address - Country:US
Mailing Address - Phone:954-223-5483
Mailing Address - Fax:954-223-5484
Practice Address - Street 1:10244 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5615
Practice Address - Country:US
Practice Address - Phone:954-223-5483
Practice Address - Fax:954-223-5484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty