Healthcare Provider Details

I. General information

NPI: 1578941761
Provider Name (Legal Business Name): ELITE PERINATOLOGY,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 NEW YORK AVE
HUNTINGTON STATION NY
11746-3258
US

IV. Provider business mailing address

1995 NEW YORK AVE
HUNTINGTON STATION NY
11746-3258
US

V. Phone/Fax

Practice location:
  • Phone: 631-923-1333
  • Fax: 631-923-1336
Mailing address:
  • Phone: 631-923-1333
  • Fax: 631-923-1336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number213604
License Number StateNY

VIII. Authorized Official

Name: DINA EL KADY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 516-504-5924