MEDICARE: ELITE NEURO DIAGNOSTIC SERVICES

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	273100000X	Epilepsy Hospital Unit

General Provider Information

NPI Number	:	1407788169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE NEURO DIAGNOSTIC SERVICES

Provider Business Mailing Address
First Line	:	37 HANOVER PL
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-3613
Country	:	US
Telephone Number	:	201-707-4799
Fax Number	:

Provider Business Practice Location Address
First Line	:	37 HANOVER PL
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-3613
Country	:	US
Telephone Number	:	201-707-4799
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW ZAITOUN
Credential	:	TECHNOLOGIST
Telephone Number	:	201-707-4799

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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