Basic Information
| Provider Information | |||||||||
| NPI: | 1992736300 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EXCELCARE MEDICAL ASSOCIATES, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 718 TEANECK ROAD | ||||||||
| Address2: | |||||||||
| City: | TEANECK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076660000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018337265 | ||||||||
| FaxNumber: | 2012276207 | ||||||||
| Practice Location | |||||||||
| Address1: | 375 SOUTH WASHINGTON AVE | ||||||||
| Address2: | EXCELCARE MEDICAL ASSOCIATES, PA | ||||||||
| City: | BERGENFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076210000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9201384003 | ||||||||
| FaxNumber: | 2013847304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 01/12/2012 | ||||||||
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| AuthorizedOfficialLastName: | JARRETT | ||||||||
| AuthorizedOfficialFirstName: | ADAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF MEDICAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2018333000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0108251 | 05 | NJ | MEDICAID |