Basic Information
| Provider Information | |||||||||
| NPI: | 1053316844 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VIRTUA WILLINGBORO HOSPITAL INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | VIRTUA HEALTH & WELLNESS CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 WEST STOW ROAD | ||||||||
| Address2: | SUITE 8 ATTN: CHRISTINE GORDON | ||||||||
| City: | MARLTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080533150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563550655 | ||||||||
| FaxNumber: | 8563550621 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 RIGHTSTOWN-COOKSTOWN ROAD | ||||||||
| Address2: | |||||||||
| City: | COOKSTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 085111019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098353056 | ||||||||
| FaxNumber: | 6098353061 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2005 | ||||||||
| LastUpdateDate: | 01/21/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KIRBY | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT VIRTUA WILLINGBORO HOSP | ||||||||
| AuthorizedOfficialTelephone: | 6099146202 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | VIRTUA HEALTH INC | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 10303 | NJ | Y | Hospitals | General Acute Care Hospital |
No ID Information.