Organization Active NPI

Virtua Medical Group, PA

Doing business as Rowan Medicine Psychiatry - Mount Laurel, an affiliate of VMG

  • Psychiatry Physician
  • Mount Laurel, NJ
National Provider Identifier
1417219619
Registry record updated Jun 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
VIRTUA MEDICAL GROUP, PA
Doing business as
Rowan Medicine Psychiatry - Mount Laurel, an affiliate of VMG
Practice address
100 Century Pkwy Ste 350
Mount Laurel, NJ 08054-1149
Phone
(856) 482-9000
Fax
(856) 482-1159
NPI assigned
Jun 13, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John Mark Matsinger, DO
Title
Evp; Chief Operating Officer
Phone
(856) 355-0340

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

100 Century Pkwy Ste 350
Mount Laurel, NJ 08054-1149

Mailing address

301 Lippincott Dr Ste 410
Marlton, NJ 08053-4197
Phone (856) 355-0340

Other names 1

  • Rowan Medicine Psychiatry - Mount Laurel, an affiliate of VMG Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D0724656Rowan Family Medicine - Mt Laurel100 Century Parkway, Mount Laurel, NJ 08054Provider-performed microscopyFeb 23, 2027
31D2300336Rowan Psychiatry100 Century Parkway, Suite 350, Mount Laurel, NJ 08054Certificate of waiverMar 6, 2028

National Provider Directory

National Provider Directory

Locations

100 Kings Way E
Ste D3A
Sewell, NJ 08080
Phone (856) 341-8495

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717977600000",
    "number": "1417219619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 LIPPINCOTT DR STE 410",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080534197",
            "telephone_number": "856-355-0340",
            "fax_number": "856-355-0330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CENTURY PKWY STE 350",
            "city": "MOUNT LAUREL",
            "state": "NJ",
            "postal_code": "080541149",
            "telephone_number": "856-482-9000",
            "fax_number": "856-482-1159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIRTUA MEDICAL GROUP, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-13",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A",
        "authorized_official_last_name": "MATSINGER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "EVP; CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "856-355-0340",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rowan Medicine Psychiatry - Mount Laurel, an affiliate of VMG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Laurel, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.