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General NPI Number Information
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NPI Number | 1265532436
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Entity Type | Organization
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Legal Business Name | DEPT. VETERANS AFFAIRS
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 08/08/2008
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Provider Practice Location Address
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Address Line | 151 KNOLLCROFT RD BLDG. 57
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City | LYONS
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State | NJ
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Zip | 07939-5001
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Country | US
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Telephone | 908-647-0180
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Fax | 908-604-5850
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Provider Business Mailing Address
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Address Line | 52 HERCULES RD
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City | KENVIL
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State | NJ
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Zip | 07847-2579
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Country | US
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Telephone | 973-927-7044
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Fax |
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Authorized Official
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Title or Position | CLINICAL COORDINATOR
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Name | MS. SUSAN LEE MOORE-MAGEE
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Credential | MSW, LCSW
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Telephone | 908-647-0180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 44SC00041400
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License Number State | NJ
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