Healthcare Provider Details

I. General information

NPI: 1053241828
Provider Name (Legal Business Name): JAMIE BOWDEN CCMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 ROUTE 47 SOUTH, SUITE WU-N, 2ND FL
RIO GRANDE NJ
08242
US

IV. Provider business mailing address

1304 ROUTE 47 SOUTH, SUITE WU-N, 2ND FL
RIO GRANDE NJ
08242
US

V. Phone/Fax

Practice location:
  • Phone: 609-231-4292
  • Fax: 609-231-4292
Mailing address:
  • Phone: 609-231-4292
  • Fax: 609-231-4292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberQ2W3E6A8
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: