Provider Demographics
NPI:1245077940
Name:ELITE SPINE AND SPORTS CARE OF PARAMUS CORPORATION
Entity type:Organization
Organization Name:ELITE SPINE AND SPORTS CARE OF PARAMUS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCORPORATOR
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:201-563-7095
Mailing Address - Street 1:37 W CENTURY RD STE 111
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-1466
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:37 W CENTURY RD STE 111
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1466
Practice Address - Country:US
Practice Address - Phone:201-677-8667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy