Healthcare Provider Details

I. General information

NPI: 1053758466
Provider Name (Legal Business Name): ELITE MEDICAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2013
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 PROFESSIONAL VIEW DR 2ND FLOOR
FREEHOLD NJ
07728-7904
US

IV. Provider business mailing address

318 PROFESSIONAL VIEW DR 2ND FLOOR
FREEHOLD NJ
07728-7904
US

V. Phone/Fax

Practice location:
  • Phone: 732-409-6440
  • Fax: 732-409-6466
Mailing address:
  • Phone: 732-409-6440
  • Fax: 732-409-6466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA06957200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMA06957200
License Number StateNJ

VIII. Authorized Official

Name: SANJIV K SHARMA
Title or Position: OWNER
Credential: MD
Phone: 732-409-6440