Provider Demographics
NPI:1629856596
Name:ELITEDENT MANAGEMENT LLC
Entity Type:Organization
Organization Name:ELITEDENT MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEET
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAINANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-933-1222
Mailing Address - Street 1:301 SLOSSON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4509
Mailing Address - Country:US
Mailing Address - Phone:718-448-3366
Mailing Address - Fax:718-448-3371
Practice Address - Street 1:1476 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-1923
Practice Address - Country:US
Practice Address - Phone:347-933-1222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care