1386282366 NPI number — ELITE MOVEMENT INITIATIVE LLC

Table of content: (NPI 1386282366)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386282366 NPI number — ELITE MOVEMENT INITIATIVE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELITE MOVEMENT INITIATIVE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386282366
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6155 98TH ST APT 16H
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REGO PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11374-1439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2244 JACKSON AVE APT 820
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG ISLAND CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11101-9410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-308-5225
Provider Business Practice Location Address Fax Number:
201-591-7839
Provider Enumeration Date:
12/20/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHETH
Authorized Official First Name:
BHAVIK
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
718-308-5225

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)