MEDICARE: ELITE HEALTH & WELLNESS CENTER PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1720652100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE HEALTH & WELLNESS CENTER PC

Provider Business Mailing Address
First Line	:	1585 FRONT STREET
Second Line	:	SUITE 200
City	:	EAST MEDOW
State	:	NY
Zip	:	11554
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1585 FRONT STREET
Second Line	:	SUITE 200
City	:	EAST MEDOW
State	:	NY
Zip	:	11554
Country	:	US
Telephone Number	:	914-376-6100
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BILLY FORD
Credential	:	MD
Telephone Number	:	914-376-6100

Provider Enumeration Date	:	05/19/2021
Last Update Date	:	05/19/2021

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