Basic Information
| Provider Information | |||||||||
| NPI: | 1003926080 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VANJ HEALTH CARE SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 80 MAPLE AVE | ||||||||
| Address2: | |||||||||
| City: | WEST ORANGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070522418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737364297 | ||||||||
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| Practice Location | |||||||||
| Address1: | 151 KNOLLCROFT RD | ||||||||
| Address2: | |||||||||
| City: | LYONS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079395001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9086470180 | ||||||||
| FaxNumber: | 9086045273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 08/01/2008 | ||||||||
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| AuthorizedOfficialLastName: | RHEW | ||||||||
| AuthorizedOfficialFirstName: | JI JIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | ATTENDING PSYCHIATRIST | ||||||||
| AuthorizedOfficialTelephone: | 9086470180 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 40076 | MA | Y | Hospitals | General Acute Care Hospital |
No ID Information.