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General NPI Number Information
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NPI Number | 1861406860
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Entity Type | Organization
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Legal Business Name | VA NEW JERSEY HEALTHCARE SYSTEM
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 151 KNOLLCROFT RD
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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 | 908-625-5635
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Fax |
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Provider Business Mailing Address
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Address Line | 215 MAIN ST APT-76
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City | SOUTH BOUND BROOK
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State | NJ
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Zip | 08880-1486
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Country | US
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Telephone | 908-625-5635
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Fax | 908-252-9098
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Authorized Official
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Title or Position | MAINTAINANCE CONTROL MANAGER
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Name | MR. EDWARD JAMES DOUGHTY
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Credential | CADC
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Telephone | 908-252-9075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 37CA00021700
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License Number State | NJ
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