Healthcare Provider Details

I. General information

NPI: 1669446621
Provider Name (Legal Business Name): ROWANSOM DEPT OF GASTROENTEROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 E LAUREL RD SUITE 3500
STRATFORD NJ
08084-1354
US

IV. Provider business mailing address

42 E LAUREL RD SUITE 3500
STRATFORD NJ
08084-1354
US

V. Phone/Fax

Practice location:
  • Phone: 856-566-6853
  • Fax: 856-566-7002
Mailing address:
  • Phone: 856-566-6853
  • Fax: 856-566-7002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

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