Provider Demographics
NPI:1215755418
Name:ELITE
Entity type:Organization
Organization Name:ELITE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:INNA
Authorized Official - Middle Name:
Authorized Official - Last Name:YASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-691-7599
Mailing Address - Street 1:6220 SW 144TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33158-1827
Mailing Address - Country:US
Mailing Address - Phone:732-691-7599
Mailing Address - Fax:
Practice Address - Street 1:6220 SW 144TH ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33158-1827
Practice Address - Country:US
Practice Address - Phone:732-691-7599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center