Healthcare Provider Details

I. General information

NPI: 1477472058
Provider Name (Legal Business Name): ELITE LEARNING STUDIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 RICHMOND AVE
STATEN ISLAND NY
10312
US

IV. Provider business mailing address

3930 RICHMOND AVE
STATEN ISLAND NY
10312
US

V. Phone/Fax

Practice location:
  • Phone: 347-278-1019
  • Fax:
Mailing address:
  • Phone: 347-278-1019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNY C ORTVI
Title or Position: DIRECTOR
Credential: M.S.
Phone: 718-612-4802