Healthcare Provider Details

I. General information

NPI: 1730896069
Provider Name (Legal Business Name): VT ONE STOP SHOP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 11/07/2022
Certification Date: 11/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2906 MOUNT EPHRAIM AVE
HADDON TOWNSHIP NJ
08104-3216
US

IV. Provider business mailing address

2906 MOUNT EPHRAIM AVE
HADDON TOWNSHIP NJ
08104-3216
US

V. Phone/Fax

Practice location:
  • Phone: 856-259-7260
  • Fax:
Mailing address:
  • Phone: 856-259-7260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VERONICA TUCKER
Title or Position: PRESIDENT
Credential:
Phone: 856-259-7260