Healthcare Provider Details

I. General information

NPI: 1053254425
Provider Name (Legal Business Name): ELITE MEDICAL & BEHAVIORAL CARE SERVICES LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 INDIGO RD
HACKETTSTOWN NJ
07840-4540
US

IV. Provider business mailing address

11 INDIGO RD
HACKETTSTOWN NJ
07840-4540
US

V. Phone/Fax

Practice location:
  • Phone: 646-326-6071
  • Fax:
Mailing address:
  • Phone: 646-326-6071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NAFISAH ABDULSALAM
Title or Position: NP
Credential: DNP
Phone: 646-326-6071