Provider Demographics
NPI:1508491903
Name:ELITE SPECIALTY CARE, PC
Entity Type:Organization
Organization Name:ELITE SPECIALTY CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NIZAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KIFAIEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MB, CPE, FACEP
Authorized Official - Phone:201-741-0225
Mailing Address - Street 1:55 MEADOWLANDS PKWY
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-2977
Mailing Address - Country:US
Mailing Address - Phone:888-372-3627
Mailing Address - Fax:973-305-8818
Practice Address - Street 1:55 MEADOWLANDS PKWY
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-2977
Practice Address - Country:US
Practice Address - Phone:888-372-3627
Practice Address - Fax:973-305-8818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty