Healthcare Provider Details

I. General information

NPI: 1043226806
Provider Name (Legal Business Name): V.A.N.J.HEALTHCARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 KNOLLCROFT RD BLDG. 57
LYONS NJ
07939-5001
US

IV. Provider business mailing address

4533 LANDISVILLE RD
DOYLESTOWN PA
18901-1246
US

V. Phone/Fax

Practice location:
  • Phone: 908-647-0180
  • Fax: 908-604-5850
Mailing address:
  • Phone: 215-348-1886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberSW005596E
License Number StatePA

VIII. Authorized Official

Name: MR. RICHARD WILLARD LISBON
Title or Position: SOCIAL WORKER
Credential: M.S.W.,L.C.S.W.
Phone: 908-647-0180