Provider Demographics
NPI:1699000745
Name:ELITE LASER AND MEDICAL COSMETICS
Entity Type:Organization
Organization Name:ELITE LASER AND MEDICAL COSMETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BELFIORE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-371-5800
Mailing Address - Street 1:2209 MERRICK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4786
Mailing Address - Country:US
Mailing Address - Phone:516-371-5800
Mailing Address - Fax:516-371-3712
Practice Address - Street 1:2209 MERRICK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4786
Practice Address - Country:US
Practice Address - Phone:516-371-5800
Practice Address - Fax:516-371-3712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200906261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty