Healthcare Provider Details

I. General information

NPI: 1043658222
Provider Name (Legal Business Name): ELITE UDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 CENTRAL AVE SUITE 109
LAWRENCE NY
11559-8507
US

IV. Provider business mailing address

290 CENTRAL AVE SUITE 109
LAWRENCE NY
11559-8507
US

V. Phone/Fax

Practice location:
  • Phone: 516-239-8877
  • Fax:
Mailing address:
  • Phone: 516-239-8877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number168657
License Number StateNY

VIII. Authorized Official

Name: DR. SHELDON PIKE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 516-239-8877