Provider Demographics
NPI:1205512126
Name:EXCEL MEDICAL GROUP PC
Entity type:Organization
Organization Name:EXCEL MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:HUSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-378-3608
Mailing Address - Street 1:7511 BERGENLINE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-5459
Mailing Address - Country:US
Mailing Address - Phone:201-378-3608
Mailing Address - Fax:
Practice Address - Street 1:7511 BERGENLINE AVE STE 101
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5459
Practice Address - Country:US
Practice Address - Phone:201-378-3608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-26
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health