Basic Information
| Provider Information | |||||||||
| NPI: | 1255651543 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VETERANS AFFAIRS MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 255 JOHN F KENNEDY BLVD | ||||||||
| Address2: | |||||||||
| City: | LAWNSIDE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080451035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158235800 | ||||||||
| FaxNumber: | 2158234248 | ||||||||
| Practice Location | |||||||||
| Address1: | 3900 WOODLAND AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191044551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158235800 | ||||||||
| FaxNumber: | 2158235800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2010 | ||||||||
| LastUpdateDate: | 06/09/2010 | ||||||||
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| AuthorizedOfficialLastName: | FELIX | ||||||||
| AuthorizedOfficialFirstName: | SANDRA | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | SOCIAL WORKER | ||||||||
| AuthorizedOfficialTelephone: | 2158235800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MSW,LSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2865M2000X | 8218 | TN | Y | Hospitals | Military Hospital | Military General Acute Care Hospital |
No ID Information.