Provider Demographics
NPI:1912746736
Name:ELITE-R-US LLC
Entity type:Organization
Organization Name:ELITE-R-US LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:518-818-9053
Mailing Address - Street 1:1146 DUNAD AVE
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-3412
Mailing Address - Country:US
Mailing Address - Phone:518-818-9053
Mailing Address - Fax:
Practice Address - Street 1:1146 DUNAD AVE
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-3412
Practice Address - Country:US
Practice Address - Phone:518-818-9053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty