=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174529846
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VIRTUA - MEMORIAL HOSPITAL BURLINGTON COUNTY, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2005
-----------------------------------------------------
Last Update Date | 04/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 175 MADISON AVE
-----------------------------------------------------
City | MOUNT HOLLY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08060-2038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-267-0700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 406 LIPPINCOTT DR STE J ATTN: CHRISTINE GORDON
-----------------------------------------------------
City | MARLTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08053-4168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-355-0655
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP FOR FINANCE
-----------------------------------------------------
Name | MR. GERRY LOWE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 856-355-0604
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 273R00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital Unit
-----------------------------------------------------
License Number | 10301
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------