Healthcare Provider Details

I. General information

NPI: 1659177582
Provider Name (Legal Business Name): XCELLCARE MEDICAL PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 AVENEL ST
AVENEL NJ
07001-1150
US

IV. Provider business mailing address

432 AVENEL ST
AVENEL NJ
07001-1150
US

V. Phone/Fax

Practice location:
  • Phone: 845-481-1953
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MUHAMMAD AFZAL KHAN
Title or Position: OWNER
Credential: MD
Phone: 845-481-1953