Healthcare Provider Details

I. General information

NPI: 1396079521
Provider Name (Legal Business Name): ELITE OFFICE BASED SURGERY,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5925 15TH AVE
BROOKLYN NY
11219-5009
US

IV. Provider business mailing address

5925 15TH AVE
BROOKLYN NY
11219-5009
US

V. Phone/Fax

Practice location:
  • Phone: 718-972-2700
  • Fax:
Mailing address:
  • Phone: 718-972-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW SILVERMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-972-2700