Healthcare Provider Details

I. General information

NPI: 1457247637
Provider Name (Legal Business Name): ROTHMAN AND KIM OMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 WYNWOOD DR
CINNAMINSON NJ
08077-3033
US

IV. Provider business mailing address

1701 WYNWOOD DR
CINNAMINSON NJ
08077-3033
US

V. Phone/Fax

Practice location:
  • Phone: 856-829-9666
  • Fax:
Mailing address:
  • Phone: 856-829-9666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: CHAD HENDRICKS
Title or Position: CREDENTIALING
Credential:
Phone: 612-859-0444