Healthcare Provider Details

I. General information

NPI: 1801616677
Provider Name (Legal Business Name): VIRTUA - WEST JERSEY HEALTH SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 LIPPINCOTT DR FL 2
MARLTON NJ
08053-4197
US

IV. Provider business mailing address

301 LIPPINCOTT DR FL 2
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-581-7310
  • Fax: 856-581-7311
Mailing address:
  • Phone: 856-581-7200
  • Fax: 856-325-5282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE C GORDON
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential: MBA
Phone: 856-355-0655