Provider Demographics
NPI:1689682478
Name:U.S. DEPT. OF VETERANS AFFAIRS
Entity Type:Organization
Organization Name:U.S. DEPT. OF VETERANS AFFAIRS
Other - Org Name:V.A. N.J. HEALTH CARE SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF,PHYSICAL MEDICINE REHAB SERVI
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAE
Authorized Official - Middle Name:
Authorized Official - Last Name:IM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-676-1000
Mailing Address - Street 1:155 KNOLLCROFT RD
Mailing Address - Street 2:BUILDING 143,ROOM WII8
Mailing Address - City:LYONS
Mailing Address - State:NJ
Mailing Address - Zip Code:07939-5001
Mailing Address - Country:US
Mailing Address - Phone:908-647-0180
Mailing Address - Fax:
Practice Address - Street 1:155 KNOLLCROFT RD
Practice Address - Street 2:BUILDING 143,ROOM WII8
Practice Address - City:LYONS
Practice Address - State:NJ
Practice Address - Zip Code:07939-5001
Practice Address - Country:US
Practice Address - Phone:908-647-0180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00254000283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital