Provider Demographics
NPI:1366441677
Name:EXCALIBUR MEDICAL IMAGING, LLC
Entity Type:Organization
Organization Name:EXCALIBUR MEDICAL IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-482-2900
Mailing Address - Street 1:710 DOMINION DR
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-4404
Mailing Address - Country:US
Mailing Address - Phone:856-482-2900
Mailing Address - Fax:856-482-5127
Practice Address - Street 1:710 DOMINION DR
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-4404
Practice Address - Country:US
Practice Address - Phone:856-482-2900
Practice Address - Fax:856-482-5127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3860507Medicaid
NJ3860507Medicaid
NJ647943RQ4Medicare ID - Type Unspecified