1497778377 NPI number — EXEL-MED INC

Table of content: (NPI 1497778377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497778377 NPI number — EXEL-MED INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXEL-MED INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497778377
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2301 EVESHAM RD
Provider Second Line Business Mailing Address:
STE 504 PAVILIONS OF VOORHEES
Provider Business Mailing Address City Name:
VOORHEES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-651-1400
Provider Business Mailing Address Fax Number:
856-651-1401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2301 EVESHAM RD
Provider Second Line Business Practice Location Address:
STE 504 PAVILIONS OF VOORHEES
Provider Business Practice Location Address City Name:
VOORHEES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-651-1400
Provider Business Practice Location Address Fax Number:
856-651-1401
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAMATY
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT PHYSICIAN
Authorized Official Telephone Number:
856-651-1400

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207RC0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1728117 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 60000105 . This is a "HORIZON NJ HEALTH & FIRST" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2396187002 . This is a "AMERI HLTH KEYSTONE PCP H" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 6781101 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 06257 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 537 . This is a "AETNA HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2396187000 . This is a "AMERI HLTH KEYSTONE PULMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4454791 . This is a "AETNA PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: CM4661 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: EX1485119 . This is a "HIGHMARK BCBS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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