Healthcare Provider Details

I. General information

NPI: 1245249002
Provider Name (Legal Business Name): ROWEN PODIATRY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 05/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 BLACK HORSE PIKE
GLENDORA NJ
08029-1443
US

IV. Provider business mailing address

518 BLACK HORSE PIKE
GLENDORA NJ
08029-1443
US

V. Phone/Fax

Practice location:
  • Phone: 856-939-2411
  • Fax: 856-939-1718
Mailing address:
  • Phone: 856-939-2411
  • Fax: 856-939-1718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25,D00214500
License Number StateNJ

VIII. Authorized Official

Name: MICHELLE C ROWEN
Title or Position: DPM
Credential: DPM
Phone: 856-939-2411