Healthcare Provider Details

I. General information

NPI: 1598692261
Provider Name (Legal Business Name): ELITE ORTHOMED SUPPLY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3098 51ST ST
WOODSIDE NY
11377-1457
US

IV. Provider business mailing address

3098 51ST ST
WOODSIDE NY
11377-1457
US

V. Phone/Fax

Practice location:
  • Phone: 347-547-4693
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL

VIII. Authorized Official

Name: ARTHUR YAKUBOV
Title or Position: PRESIDENT
Credential:
Phone: 347-547-4693