Provider Demographics
NPI:1790299543
Name:ADVANCE ELITE SOLUTION LLC
Entity Type:Organization
Organization Name:ADVANCE ELITE SOLUTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAYZIBAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-660-3895
Mailing Address - Street 1:10516 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-2013
Mailing Address - Country:US
Mailing Address - Phone:917-660-3895
Mailing Address - Fax:
Practice Address - Street 1:10516 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-2013
Practice Address - Country:US
Practice Address - Phone:917-660-3895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-30
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2427L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health