Healthcare Provider Details

I. General information

NPI: 1326486408
Provider Name (Legal Business Name): SHIRA R ROSENBAUM-ROLLER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E EVESHAM RD BUILDING 800, SUITE 122
VOORHEES NJ
08043-4501
US

IV. Provider business mailing address

404 KENNEBEC RD
CHERRY HILL NJ
08002-1633
US

V. Phone/Fax

Practice location:
  • Phone: 856-770-9300
  • Fax:
Mailing address:
  • Phone: 917-683-3613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: