Provider Demographics
NPI:1588834386
Name:LOURDES MEDICAL CENTER OF BURLINGTON COUNTY
Entity Type:Organization
Organization Name:LOURDES MEDICAL CENTER OF BURLINGTON COUNTY
Other - Org Name:LMCBC WOMEN'S HEALTHCARE OF BURLINGTON COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-835-3061
Mailing Address - Street 1:500 GROVE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1702
Mailing Address - Country:US
Mailing Address - Phone:856-796-9200
Mailing Address - Fax:856-310-5603
Practice Address - Street 1:220 SUNSET RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1126
Practice Address - Country:US
Practice Address - Phone:609-835-5204
Practice Address - Fax:609-835-5267
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOURDES MEDICAL CENTER OF BURLINGTON COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-07
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02743800207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ310061AMedicare PIN