Provider Demographics
NPI:1801262258
Name:ELITE PHYSICAL MEDICINE LLC
Entity type:Organization
Organization Name:ELITE PHYSICAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-944-5999
Mailing Address - Street 1:101 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-1007
Mailing Address - Country:US
Mailing Address - Phone:201-944-5999
Mailing Address - Fax:201-947-3994
Practice Address - Street 1:101 GRAND AVE
Practice Address - Street 2:
Practice Address - City:PALISADES PARK
Practice Address - State:NJ
Practice Address - Zip Code:07650-1007
Practice Address - Country:US
Practice Address - Phone:201-944-5999
Practice Address - Fax:201-947-3994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty