Healthcare Provider Details

I. General information

NPI: 1326961384
Provider Name (Legal Business Name): ELITE MEDICAL CARE IA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 N RIVER BLVD NE STE 236
CEDAR RAPIDS IA
52411-6678
US

IV. Provider business mailing address

407 WILLOUGHBY AVE
BROOKLYN NY
11205-4590
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-0288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: AZLAN TARIQ
Title or Position: OWNER
Credential:
Phone: 718-470-0288