1144770975 NPI number — VIRTUA MEDICAL GROUP, PA

Table of content: (NPI 1144770975)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144770975 NPI number — VIRTUA MEDICAL GROUP, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIRTUA MEDICAL GROUP, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VIRTUA EXPRESS URGENT CARE - MEDFORD
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144770975
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 LIPPINCOTT DR STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARLTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08053-4197
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-355-0340
Provider Business Mailing Address Fax Number:
856-355-0346

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
128 ROUTE 70
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-367-0900
Provider Business Practice Location Address Fax Number:
609-367-0901
Provider Enumeration Date:
10/05/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MATSINGER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
MARK
Authorized Official Title or Position:
EVP; SYSTEM CHIEF CLINICAL OFFICER
Authorized Official Telephone Number:
856-355-0340

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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