Organization Name: | EXCALIBUR HEALTHCARE |
NPI Number: | 1659727741 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GENNIE LEBRON (OPERATIONS) |
Mailing Address: | 1000 S Lenola Rd Building One, Suite 105 Maple Shade |
State: | NJ US |
Postal Code: | 080521630 |
Phone Number: | 8562314300 |
Fax Number: | |
NPI Enumeration Date: | 05/09/2016 |
NPI Last Update Date: | 05/09/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR0200X |
License Number: | 25MA04604900 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Radiology |
Taxonomy Definition: |