=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578161535
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VIRTUA - WEST JERSEY HEALTH SYSTEM, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2020
-----------------------------------------------------
Last Update Date | 10/13/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 165 ROUTE 73
-----------------------------------------------------
City | VOORHEES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08043-9526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-355-0860
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 303 LIPPINCOTT DR FL 2 ATTN: LAUREN OCHS
-----------------------------------------------------
City | MARLTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08053-4160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-355-0860
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF REIMBURSEMENT
-----------------------------------------------------
Name | CHRISTINE C GORDON
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 856-355-0655
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QB0400X
-----------------------------------------------------
Taxonomy Name | Birthing Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------