Provider Demographics
NPI:1497525638
Name:ELITE ADULT AND SENIOR PRACTICE INC
Entity Type:Organization
Organization Name:ELITE ADULT AND SENIOR PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OBIOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ONAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-393-5187
Mailing Address - Street 1:21726 138TH RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2608
Mailing Address - Country:US
Mailing Address - Phone:347-393-5187
Mailing Address - Fax:
Practice Address - Street 1:21726 138TH RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-2608
Practice Address - Country:US
Practice Address - Phone:347-393-5187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty