Healthcare Provider Details

I. General information

NPI: 1003413311
Provider Name (Legal Business Name): EXCELSIOR SERVICES GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 MAIN AVE
WOOD RIDGE NJ
07075-2055
US

IV. Provider business mailing address

415 MAIN AVE
WOOD RIDGE NJ
07075-2055
US

V. Phone/Fax

Practice location:
  • Phone: 917-463-6166
  • Fax:
Mailing address:
  • Phone: 917-463-6166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MONICA ELKESHK
Title or Position: EXECUTIVE DIRECTOR
Credential: FNP-BC
Phone: 917-463-6166