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General NPI Number Information
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NPI Number | 1881668846
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Entity Type | Organization
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Legal Business Name | ROWANSOM NEWJERSEY INSTITUTE FOR SUCCESSFUL AGING-GERIATRIC PSYCHIATRY
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Dates
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Enumeration Date | 02/15/2006
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Last Update Date | 05/15/2013
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Provider Practice Location Address
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Address Line | 42 EAST LAUREL ROAD UDP, SUITE 1800
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City | STRATFORD
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State | NJ
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Zip | 08084
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Country | US
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Telephone | 856-566-6843
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Fax | 856-566-6419
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Provider Business Mailing Address
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Address Line | PO BOX 635
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City | BELLMAWR
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State | NJ
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Zip | 08099-0635
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Country | US
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Telephone | 856-566-6706
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Fax | 856-566-2797
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Authorized Official
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Title or Position | INTERIM CHIEF FINANCIAL OFFICIER
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #4
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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 |
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