MEDICARE: VIRTUA WILLINGBORO HOSPITAL, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	273R00000X	Psychiatric Hospital Unit	10303	NJ

General Provider Information

NPI Number	:	1285630087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRTUA WILLINGBORO HOSPITAL, INC.

Provider Business Mailing Address
First Line	:	406 LIPPINCOTT DR STE J
Second Line	:	ATTN: CHRISTINE GORDON
City	:	MARLTON
State	:	NJ
Zip	:	08053-4168
Country	:	US
Telephone Number	:	856-355-0655
Fax Number	:	856-355-0621

Provider Business Practice Location Address
First Line	:	218A SUNSET ROAD
Second Line	:
City	:	WILLINGBORO
State	:	NJ
Zip	:	08046-1110
Country	:	US
Telephone Number	:	609-835-2900
Fax Number	:	609-835-3061

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN KIRBY
Credential	:
Telephone Number	:	609-914-6202

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	04/15/2025

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