Healthcare Provider Details

I. General information

NPI: 1538312624
Provider Name (Legal Business Name): ROTHMAN INSTITUTE OF NEW JERSEY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 ROUTE 73 N THIRD FLOOR
MARLTON NJ
08053-1227
US

IV. Provider business mailing address

999 ROUTE 73 N THIRD FLOOR
MARLTON NJ
08053-1227
US

V. Phone/Fax

Practice location:
  • Phone: 856-821-6360
  • Fax: 856-821-6359
Mailing address:
  • Phone: 856-821-6360
  • Fax: 856-821-6359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL E. WEST
Title or Position: CEO
Credential:
Phone: 267-339-3680