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General NPI Number Information
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NPI Number | 1497525638
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Entity Type | Organization
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Legal Business Name | ELITE ADULT AND SENIOR PRACTICE INC
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Dates
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Enumeration Date | 01/08/2024
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Last Update Date | 04/12/2025
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Provider Practice Location Address
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Address Line | 1420 BUSHWICK AVE
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City | BROOKLYN
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State | NY
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Zip | 11207-1422
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Country | US
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Telephone | 718-772-7951
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Fax | 718-808-0043
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Provider Business Mailing Address
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Address Line | 21726 138TH RD
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City | SPRINGFIELD GARDENS
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State | NY
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Zip | 11413-2608
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Country | US
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Telephone | 347-393-5187
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Fax | 718-808-0043
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Authorized Official
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Title or Position | OWNER
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Name | OBIOMA ONAH
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Credential |
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Telephone | 347-393-5187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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