Provider Demographics
NPI:1700909629
Name:DELAWARE VALLEY MEDICAL, INC.
Entity Type:Organization
Organization Name:DELAWARE VALLEY MEDICAL, INC.
Other - Org Name:DELAWARE VALLEY MEDICAL, INC. BLACKWOOD CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:VOORHIS
Authorized Official - Suffix:
Authorized Official - Credentials:BA, CADC, CCS
Authorized Official - Phone:856-665-5100
Mailing Address - Street 1:PO BOX 8697
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-8697
Mailing Address - Country:US
Mailing Address - Phone:856-665-5100
Mailing Address - Fax:856-665-5212
Practice Address - Street 1:300 WOODBURY TURNERSVILLE RD
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-2860
Practice Address - Country:US
Practice Address - Phone:856-227-5254
Practice Address - Fax:856-665-5212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ20000238-07261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJAPPLIED FORMedicaid