Healthcare Provider Details

I. General information

NPI: 1770419129
Provider Name (Legal Business Name): ELITE LEARNING STUDIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 MARISA CIR
STATEN ISLAND NY
10309-2054
US

IV. Provider business mailing address

3930 RICHMOND AVE
STATEN ISLAND NY
10312-5104
US

V. Phone/Fax

Practice location:
  • Phone: 718-612-4802
  • Fax: 718-612-4802
Mailing address:
  • Phone: 718-612-4802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNY ORTIZ
Title or Position: PRESIDENT
Credential: MS
Phone: 718-612-4802