Organization
EXCALIBUR HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GENNIE LEBRON (OPERATIONS)
(856) 231-4300
Entity
Organization
Contact information
Practice address
1000 S LENOLA RD, BUILDING ONE, SUITE 105, MAPLE SHADE, NJ 08052-1630
(856) 231-4300
Mailing address
1000 S LENOLA RD, BUILDING ONE, SUITE 105, MAPLE SHADE, NJ 08052-1630
(856) 231-4300
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
25MA04604900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G8865226
MEDICARE PTAN
NJ
Enumeration date
05/09/2016
Last updated
05/09/2016
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