Healthcare Provider Details

I. General information

NPI: 1922590884
Provider Name (Legal Business Name): ROWANSOM DEPT OF NEUROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 06/05/2018
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 635
BELLMAWR NJ
08099-0635
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

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