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General NPI Number Information
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NPI Number | 1255875183
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Entity Type | Organization
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Legal Business Name | ELITE GYNECOLOGY, LLC
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Dates
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Enumeration Date | 12/12/2016
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Last Update Date | 09/20/2018
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Provider Practice Location Address
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Address Line | 1033 US HIGHWAY 46E SUITE 105
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City | CLIFTON
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State | NJ
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Zip | 07013
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Country | US
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Telephone | 718-370-2222
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Fax | 718-494-2897
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Provider Business Mailing Address
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Address Line | 14 BLEEKER PLACE
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City | STATEN ISLAND
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State | NY
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Zip | 10314
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Country | US
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Telephone | 201-978-7146
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Fax | 718-494-2897
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Authorized Official
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Title or Position | MD
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Name | DR. NOREEN KAMAL-MOSTAFAVI
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Credential | MD
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Telephone | 201-978-7146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 25MA0958200
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License Number State | NJ
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