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General NPI Number Information
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NPI Number | 1184811945
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Entity Type | Organization
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Legal Business Name | VIRTUA SURGICAL GROUP, P.A
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 03/31/2014
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Provider Practice Location Address
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Address Line | 1935 ROUTE 70 E
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City | CHERRY HILL
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State | NJ
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Zip | 08003-2117
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Country | US
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Telephone | 856-428-7700
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Fax | 856-424-9120
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Provider Business Mailing Address
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Address Line | 7000 ATRIUM WAY SUITE 6
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City | MOUNT LAUREL
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State | NJ
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Zip | 08054-3917
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Country | US
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Telephone | 856-840-4500
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Fax | 856-291-6819
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DIOSCORO VILLANUEVA
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Credential | M.D
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Telephone | 856-428-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 25MA07300800
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License Number State | NJ
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