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General NPI Number Information
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NPI Number | 1730194549
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Entity Type | Organization
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Legal Business Name | ELIM HEALTHCARE SERVICES, P.T.P.C.
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 03/22/2017
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Provider Practice Location Address
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Address Line | 19621 HILLSIDE AVE
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City | HOLLIS
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State | NY
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Zip | 11423-2124
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Country | US
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Telephone | 718-776-3129
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Fax | 718-776-3224
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Provider Business Mailing Address
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Address Line | 787 N ASCAN ST
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City | ELMONT
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State | NY
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Zip | 11003-4621
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Country | US
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Telephone | 516-561-3922
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Fax | 718-776-3224
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DUROJAIYE SHADRACH OJETAYO
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Credential | P.T.
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Telephone | 718-776-3129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 014849-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 014849-1
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License Number State | NY
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