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General NPI Number Information
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NPI Number | 1275503203
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Entity Type | Organization
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Legal Business Name | ROWANSOM DEPT OF PEDIATRICS
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Dates
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Enumeration Date | 01/24/2006
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Last Update Date | 05/03/2013
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Provider Practice Location Address
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Address Line | 405 HURFFVILLE CROSSKEYS RD SUITE 203
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City | SEWELL
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State | NJ
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Zip | 08080-9340
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Country | US
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Telephone | 856-582-0033
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Fax | 856-582-2305
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Provider Business Mailing Address
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Address Line | 405 HURFFVILLE CROSSKEYS RD SUITE 203
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City | SEWELL
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State | NJ
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Zip | 08080-9340
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Country | US
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Telephone | 856-582-0033
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Fax | 856-582-2305
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Authorized Official
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Title or Position | INTERIM CHIEF FINANCIAL OFFICER
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Name | MICHAEL RIEKER
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Credential |
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Telephone | 856-770-5729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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