Healthcare Provider Details

I. General information

NPI: 1710305800
Provider Name (Legal Business Name): MEDEXCEL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 04/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 N NEW RD
PLEASANTVILLE NJ
08232-2170
US

IV. Provider business mailing address

258 N NEW RD
PLEASANTVILLE NJ
08232-2170
US

V. Phone/Fax

Practice location:
  • Phone: 609-646-4064
  • Fax: 609-272-8526
Mailing address:
  • Phone: 609-646-4064
  • Fax: 609-272-8526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA03617900
License Number StateNJ

VIII. Authorized Official

Name: MRS. PATRICIA A VAUGHN
Title or Position: BILLING MANAGER
Credential:
Phone: 609-646-4064