Healthcare Provider Details

I. General information

NPI: 1689644122
Provider Name (Legal Business Name): ROWANSOM DEPT OF PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 03/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 CHAPEL AVE W SUITE 100
CHERRY HILL NJ
08002-2051
US

IV. Provider business mailing address

2250 CHAPEL AVE W SUITE 100
CHERRY HILL NJ
08002-2051
US

V. Phone/Fax

Practice location:
  • Phone: 856-482-9000
  • Fax: 856-482-1159
Mailing address:
  • Phone: 856-482-9000
  • Fax: 856-482-1159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL RIEKER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 856-770-5729