Healthcare Provider Details

I. General information

NPI: 1285552299
Provider Name (Legal Business Name): ELLITE MEDICO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 W 4TH ST APT D1
BROOKLYN NY
11223-1552
US

IV. Provider business mailing address

1710 W 4TH ST APT D1
BROOKLYN NY
11223-1552
US

V. Phone/Fax

Practice location:
  • Phone: 646-907-8491
  • Fax:
Mailing address:
  • Phone: 646-907-8491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MEDLEY FENTON
Title or Position: CEO
Credential: MD
Phone: 646-907-8491