MEDICARE: ROTHMAN AND KIM OMS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1457247637
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROTHMAN AND KIM OMS LLC

Provider Business Mailing Address
First Line	:	1701 WYNWOOD DR
Second Line	:
City	:	CINNAMINSON
State	:	NJ
Zip	:	08077-3033
Country	:	US
Telephone Number	:	856-829-9666
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 WYNWOOD DR
Second Line	:
City	:	CINNAMINSON
State	:	NJ
Zip	:	08077-3033
Country	:	US
Telephone Number	:	856-829-9666
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	CHAD HENDRICKS
Credential	:
Telephone Number	:	612-859-0444

Provider Enumeration Date	:	06/16/2025
Last Update Date	:	06/16/2025

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