Provider Demographics
NPI:1942248695
Name:VA NEW JERSEY HEALTH CARE SYSTEM
Entity type:Organization
Organization Name:VA NEW JERSEY HEALTH CARE SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:LUCI
Authorized Official - Middle Name:O
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:973-676-1000
Mailing Address - Street 1:109 GRAND AVE
Mailing Address - Street 2:UNIT 1 G
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3533
Mailing Address - Country:US
Mailing Address - Phone:201-541-6945
Mailing Address - Fax:
Practice Address - Street 1:385 TREMONT AVE
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1023
Practice Address - Country:US
Practice Address - Phone:973-676-1000
Practice Address - Fax:973-395-7042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
463581282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital