Provider Demographics
NPI:1306993951
Name:VISITING PHYSICIAN ASSOCIATES OF SOUTH JERSEY LLC
Entity type:Organization
Organization Name:VISITING PHYSICIAN ASSOCIATES OF SOUTH JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:REAVES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-567-9003
Mailing Address - Street 1:640 NORTH WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037
Mailing Address - Country:US
Mailing Address - Phone:609-567-9003
Mailing Address - Fax:858-373-2478
Practice Address - Street 1:640 N WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HAMMONTON(ELM)
Practice Address - State:NJ
Practice Address - Zip Code:08037
Practice Address - Country:US
Practice Address - Phone:609-567-9003
Practice Address - Fax:858-373-2478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty