MEDICARE: VIRTUA - MEMORIAL HOSPITAL OF BURLINGTON COUNTY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	385H00000X	Respite Care	70304	NJ
2	251E00000X	Home Health Agency	70304	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922004613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRTUA - MEMORIAL HOSPITAL OF BURLINGTON COUNTY, INC.

Provider Business Mailing Address
First Line	:	523 FELLOWSHIP RD
Second Line	:	STE 250
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-3414
Country	:	US
Telephone Number	:	856-581-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	523 FELLOWSHIP RD
Second Line	:	STE 250
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-3414
Country	:	US
Telephone Number	:	856-581-7200
Fax Number	:

Authorized Official
Title or Position	:	VP FOR FINANCE
Name	:	MR. GERRY LOWE
Credential	:
Telephone Number	:	856-355-0604

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	07/27/2010

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