Provider Demographics
NPI:1265565758
Name:ELITE SURGICAL SUPPLY, INC.
Entity type:Organization
Organization Name:ELITE SURGICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:XIAOWEI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOU
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:212-625-0770
Mailing Address - Street 1:81 ELIZABETH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4729
Mailing Address - Country:US
Mailing Address - Phone:212-625-0770
Mailing Address - Fax:212-625-8317
Practice Address - Street 1:81 ELIZABETH ST STE 300
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4729
Practice Address - Country:US
Practice Address - Phone:212-625-0770
Practice Address - Fax:212-625-8317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1001468332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01922861Medicaid
NY1234880001Medicare NSC