NPIMap

Organization Active NPI

Excalibur Healthcare

  • Radiology Clinic/Center
  • Maple Shade, NJ
National Provider Identifier
1659727741
Registry record updated May 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
License
25MA04604900 Issued in NJ
Legal business name
EXCALIBUR HEALTHCARE
Practice address
1000 S Lenola Rd
Building One, Suite 105
Maple Shade, NJ 08052-1630
Phone
(856) 231-4300
NPI assigned
May 9, 2016
Last updated
May 9, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Gennie Lebron
Title
Operations
Phone
(856) 231-4300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X 25MA04604900 NJ Primary

Addresses

Primary practice location

1000 S Lenola Rd
Building One, Suite 105
Maple Shade, NJ 08052-1630

Mailing address

1000 S Lenola Rd
Building One, Suite 105
Maple Shade, NJ 08052-1630
Phone (856) 231-4300

Other identifiers 1

IdentifierTypeStateIssuer
G8865226OtherNJMEDICARE PTAN

National Provider Directory

National Provider Directory
Tax ID family
Excalibur Medical Imaging PA3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1000 S Lenola Rd
Ste 105
Maple Shade, NJ 08052
Phone (856) 231-4300

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1462752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462752000000",
    "number": "1659727741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 S LENOLA RD",
            "address_2": "BUILDING ONE, SUITE 105",
            "city": "MAPLE SHADE",
            "state": "NJ",
            "postal_code": "080521630",
            "telephone_number": "856-231-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 S LENOLA RD",
            "address_2": "BUILDING ONE, SUITE 105",
            "city": "MAPLE SHADE",
            "state": "NJ",
            "postal_code": "080521630",
            "telephone_number": "856-231-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCALIBUR HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-09",
        "last_updated": "2016-05-09",
        "status": "A",
        "authorized_official_last_name": "LEBRON",
        "authorized_official_first_name": "GENNIE",
        "authorized_official_title_or_position": "OPERATIONS",
        "authorized_official_telephone_number": "856-231-4300",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "NJ",
            "license": "25MA04604900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "G8865226",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Shade, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.