Provider Demographics
NPI:1407297658
Name:VA HEALTH CARE SYSTEM
Entity Type:Organization
Organization Name:VA HEALTH CARE SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:LACADEN
Authorized Official - Last Name:PEGOLLO
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:973-539-9791
Mailing Address - Street 1:9 PONDEROSA TRL
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-3229
Mailing Address - Country:US
Mailing Address - Phone:973-539-9791
Mailing Address - Fax:973-539-9242
Practice Address - Street 1:340 W HANOVER AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-2777
Practice Address - Country:US
Practice Address - Phone:973-539-9791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00444200261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care