MEDICARE: ELITE SURGICAL SUPPLY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	1001468	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265565758
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE SURGICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	81 ELIZABETH ST STE 300
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10013-4729
Country	:	US
Telephone Number	:	212-625-0770
Fax Number	:	212-625-8317

Provider Business Practice Location Address
First Line	:	81 ELIZABETH ST STE 300
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10013-4729
Country	:	US
Telephone Number	:	212-625-0770
Fax Number	:	212-625-8317

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. XIAOWEI HOU
Credential	:	CPED
Telephone Number	:	212-625-0770

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	05/18/2015

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