Healthcare Provider Details

I. General information

NPI: 1407960313
Provider Name (Legal Business Name): DEPARTMENT OF VETERANS AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 KNOLLCROFT RD
LYONS NJ
07933
US

IV. Provider business mailing address

94 WASHINGTON ST
BERKELEY HEIGHTS NJ
07922-1040
US

V. Phone/Fax

Practice location:
  • Phone: 908-647-0180
  • Fax:
Mailing address:
  • Phone: 908-665-1833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number44SCOO756000
License Number StateNJ

VIII. Authorized Official

Name: MR. MICHAEL VICTOR MONTEMURRO
Title or Position: SOCIAL WORKER
Credential: MSW
Phone: 908-647-0180