Provider Demographics
NPI:1720359094
Name:EXCEL MEDICAL HEALTHCARE, PLLC
Entity Type:Organization
Organization Name:EXCEL MEDICAL HEALTHCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LATONIA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-496-7791
Mailing Address - Street 1:PO BOX 603
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-0570
Mailing Address - Country:US
Mailing Address - Phone:718-496-7791
Mailing Address - Fax:516-665-8079
Practice Address - Street 1:2120 HEMPSTEAD TPKE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1849
Practice Address - Country:US
Practice Address - Phone:718-496-7791
Practice Address - Fax:516-665-8079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207936207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty