Healthcare Provider Details

I. General information

NPI: 1467422287
Provider Name (Legal Business Name): ROWANSOM DEPT OF RHEUMATOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 E LAUREL RD STE 3100
STRATFORD NJ
08084-1354
US

IV. Provider business mailing address

PO BOX 71356
PHILADELPHIA PA
19176-1356
US

V. Phone/Fax

Practice location:
  • Phone: 856-566-7070
  • Fax: 856-566-5079
Mailing address:
  • Phone: 856-582-5678
  • Fax: 856-582-8868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: KELIYVETTE WORKMAN
Title or Position: DIRECTOR OF MANAGED CARE
Credential:
Phone: 856-566-6831