Healthcare Provider Details

I. General information

NPI: 1275460339
Provider Name (Legal Business Name): ELEVATED PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11805 METROPOLITAN AVE
KEW GARDENS NY
11415-2020
US

IV. Provider business mailing address

11805 METROPOLITAN AVE
KEW GARDENS NY
11415-2020
US

V. Phone/Fax

Practice location:
  • Phone: 347-238-1550
  • Fax:
Mailing address:
  • Phone: 347-238-1550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. MADILIZ LOPEZ
Title or Position: MANAGING MEMBER
Credential: FNP-BC
Phone: 347-238-1550