Provider Demographics
NPI:1255875183
Name:ELITE GYNECOLOGY, LLC
Entity type:Organization
Organization Name:ELITE GYNECOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:NOREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMAL-MOSTAFAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-978-7146
Mailing Address - Street 1:14 BLEEKER PLACE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314
Mailing Address - Country:US
Mailing Address - Phone:201-978-7146
Mailing Address - Fax:718-494-2897
Practice Address - Street 1:1033 US HIGHWAY 46E SUITE 105
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013
Practice Address - Country:US
Practice Address - Phone:718-370-2222
Practice Address - Fax:718-494-2897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0958200207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty