Provider Demographics
NPI:1194076968
Name:ELITE OBGYN PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ELITE OBGYN PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-342-7002
Mailing Address - Street 1:104 HUDSON ST STE 2
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5795
Mailing Address - Country:US
Mailing Address - Phone:201-342-7002
Mailing Address - Fax:201-342-7055
Practice Address - Street 1:104 HUDSON ST STE 2
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5795
Practice Address - Country:US
Practice Address - Phone:201-342-7002
Practice Address - Fax:201-342-7055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ199033Medicaid