Elite Surgical PA, LLC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

25MP00125900 Issued in NJ

Legal business name

ELITE SURGICAL PA, LLC

Practice address

12 Headquarters Rd
Whitehouse Station, NJ 08889-4018

Phone

(908) 397-7971

NPI assigned

Jul 26, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mindy Chen-Relovsky, PA-CNPI 1811998784

Title

Owner

Phone

(908) 397-7871

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mindy M Chen-Relovsky, PA-C

  • Surgical Physician Assistant
  • Whitehouse Station, NJ
  • NPI 1811998784
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1532563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565740800000",
    "number": "1497232003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 HEADQUARTERS RD",
            "city": "WHITEHOUSE STATION",
            "state": "NJ",
            "postal_code": "088894018",
            "telephone_number": "908-397-7971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 HEADQUARTERS RD",
            "city": "WHITEHOUSE STATION",
            "state": "NJ",
            "postal_code": "088894018",
            "telephone_number": "908-397-7971"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "99 Hudson St Fl 12",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100132815",
            "country_code": "US",
            "telephone_number": "800-221-4904",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ELITE SURGICAL PA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-26",
        "last_updated": "2019-08-14",
        "status": "A",
        "authorized_official_last_name": "CHEN-RELOVSKY",
        "authorized_official_first_name": "MINDY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "908-397-7871",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00125900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "086304AJB",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1497232003",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Whitehouse Station, NJ
• Providers in Whitehouse Station, NJ by specialty
• Physician Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.