Healthcare Provider Details

I. General information

NPI: 1891090510
Provider Name (Legal Business Name): EXCELCARE ALLIANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 S STATE ST
VINELAND NJ
08360-4851
US

IV. Provider business mailing address

76 S STATE ST
VINELAND NJ
08360-4851
US

V. Phone/Fax

Practice location:
  • Phone: 856-205-1112
  • Fax: 856-205-1114
Mailing address:
  • Phone: 856-205-1112
  • Fax: 856-205-1114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNJ

VIII. Authorized Official

Name: RAGHURAJ TOMAR
Title or Position: PRESIDENT
Credential: MD
Phone: 856-205-1112