Provider Demographics
NPI:1710169206
Name:TWSP OF HANOVER
Entity Type:Organization
Organization Name:TWSP OF HANOVER
Other - Org Name:HANOVER TOWNSHIP
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:VAN ORDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-428-2485
Mailing Address - Street 1:1000 ROUTE 10
Mailing Address - Street 2:PO BOX 250
Mailing Address - City:WHIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07981-1005
Mailing Address - Country:US
Mailing Address - Phone:973-428-2485
Mailing Address - Fax:
Practice Address - Street 1:1000 ROUTE 10
Practice Address - Street 2:
Practice Address - City:WHIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07981-1005
Practice Address - Country:US
Practice Address - Phone:973-428-2485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJA490251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ748731Medicare PIN