Healthcare Provider Details

I. General information

NPI: 1528523040
Provider Name (Legal Business Name): ROWANSOM DEPT OF UROGYNECOLOGY AND PELVIC SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 E LAUREL RD STE 2545
STRATFORD NJ
08084-1354
US

IV. Provider business mailing address

PO BOX 71356
PHILADELPHIA PA
19176-1356
US

V. Phone/Fax

Practice location:
  • Phone: 856-589-1414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

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