Healthcare Provider Details

I. General information

NPI: 1568601532
Provider Name (Legal Business Name): ELITE ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 WALL ST W
LYNDHURST NJ
07071-3621
US

IV. Provider business mailing address

1050 WALL ST W
LYNDHURST NJ
07071-3621
US

V. Phone/Fax

Practice location:
  • Phone: 201-635-1003
  • Fax:
Mailing address:
  • Phone: 201-635-1003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number StateNJ

VIII. Authorized Official

Name: DR. STEPHEN WINIKOFF
Title or Position: PRESIDENT
Credential:
Phone: 201-635-1003