Provider Demographics
NPI:1508336298
Name:ELITE SPINE AND SPORTS CARE OF FORT LEE PC
Entity Type:Organization
Organization Name:ELITE SPINE AND SPORTS CARE OF FORT LEE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNAWI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-592-0800
Mailing Address - Street 1:1622 PARKER AVE STE 2B
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6927
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1622 PARKER AVE STE 2B
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6927
Practice Address - Country:US
Practice Address - Phone:201-592-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-26
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty