# ELITE SPORTS MEDICINE AND WELLNESS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306350830
- **Authorized official:** DR. SHAI SHOSHANI MD (OWNER/PHYSICIAN)
- **Authorized official phone:** (201) 431-5115

## Contact information

- **Practice address:** 46 UNION AVE, CRESSKILL, NJ 07626-2125
- **Practice address phone:** (201) 431-5115
- **Practice address fax:** (201) 399-7697
- **Mailing address:** 46 UNION AVE, CRESSKILL, NJ 07626-2125
- **Mailing address phone:** (201) 431-5115
- **Mailing address fax:** (201) 399-7697

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | 25MA09267900 | NJ | Yes |

## Other

- **Enumeration date:** 11/20/2017
- **Last updated:** 11/20/2017