Healthcare Provider Details

I. General information

NPI: 1174529846
Provider Name (Legal Business Name): VIRTUA - MEMORIAL HOSPITAL BURLINGTON COUNTY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 MADISON AVE
MOUNT HOLLY NJ
08060-2038
US

IV. Provider business mailing address

406 LIPPINCOTT DR STE J ATTN: CHRISTINE GORDON
MARLTON NJ
08053-4168
US

V. Phone/Fax

Practice location:
  • Phone: 609-267-0700
  • Fax:
Mailing address:
  • Phone: 856-355-0655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number10301
License Number StateNJ

VIII. Authorized Official

Name: MR. GERRY LOWE
Title or Position: VP FOR FINANCE
Credential:
Phone: 856-355-0604