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General NPI Number Information
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NPI Number | 1073736609
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Entity Type | Organization
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Legal Business Name | DR. JAMES R. COWAN, JR. M.D. P.A.
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 05/18/2009
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Provider Practice Location Address
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Address Line | 61 N MAPLE AVE
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3255
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Country | US
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Telephone | 201-670-4124
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Fax | 201-670-4120
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Provider Business Mailing Address
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Address Line | 61 N MAPLE AVE SUITE # 305
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3255
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Country | US
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Telephone | 201-670-4124
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Fax | 201-670-4120
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | DR. MARYANNE LARUE COWAN I
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Credential | LCSW, PH.D.
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Telephone | 201-670-4124
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State | NJ
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