Provider Demographics
NPI:1730194549
Name:ELIM HEALTHCARE SERVICES, P.T.P.C.
Entity type:Organization
Organization Name:ELIM HEALTHCARE SERVICES, P.T.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DUROJAIYE
Authorized Official - Middle Name:SHADRACH
Authorized Official - Last Name:OJETAYO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-776-3129
Mailing Address - Street 1:787 N ASCAN ST
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4621
Mailing Address - Country:US
Mailing Address - Phone:516-561-3922
Mailing Address - Fax:718-776-3224
Practice Address - Street 1:19621 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2124
Practice Address - Country:US
Practice Address - Phone:718-776-3129
Practice Address - Fax:718-776-3224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014849-1251E00000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02778581Medicaid
NYOD4849OtherHEALTH PLAN
NY07592Medicare ID - Type UnspecifiedGHI MEDICARE
NY02778581Medicaid