Healthcare Provider Details

I. General information

NPI: 1245546027
Provider Name (Legal Business Name): LOURDES MEDICAL CENTER OF BURLINGTON COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 08/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 TRENTON RD
BROWNS MILLS NJ
08015-1705
US

IV. Provider business mailing address

500 GROVE ST SUITE 100
HADDON HEIGHTS NJ
08035-1761
US

V. Phone/Fax

Practice location:
  • Phone: 856-824-3400
  • Fax: 856-824-1403
Mailing address:
  • Phone: 856-796-9200
  • Fax: 856-310-0592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB05827400
License Number StateNJ

VIII. Authorized Official

Name: EUGENE JOHNSON
Title or Position: CCO
Credential:
Phone: 609-835-2900