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General NPI Number Information
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NPI Number | 1669281366
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Entity Type | Organization
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Legal Business Name | ELITE PHYSICIANS LLC
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 703 MAIN ST # X502
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City | PATERSON
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State | NJ
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Zip | 07503-2621
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Country | US
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Telephone | 240-408-6889
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Fax |
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Provider Business Mailing Address
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Address Line | 1122 53RD ST APT 507
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City | NORTH BERGEN
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State | NJ
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Zip | 07047-3158
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Country | US
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Telephone | 240-408-6889
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GAUTAM GUPTA
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Credential | MD
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Telephone | 240-408-6889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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