MEDICARE: ROWANSOM DEPT OF PEDIATRICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0433159006	OTHER	NJ	AMERIHEALTH
2	2110070	OTHER	NJ	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275503203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROWANSOM DEPT OF PEDIATRICS

Provider Business Mailing Address
First Line	:	405 HURFFVILLE CROSSKEYS RD
Second Line	:	SUITE 203
City	:	SEWELL
State	:	NJ
Zip	:	08080-9340
Country	:	US
Telephone Number	:	856-582-0033
Fax Number	:	856-582-2305

Provider Business Practice Location Address
First Line	:	405 HURFFVILLE CROSSKEYS RD
Second Line	:	SUITE 203
City	:	SEWELL
State	:	NJ
Zip	:	08080-9340
Country	:	US
Telephone Number	:	856-582-0033
Fax Number	:	856-582-2305

Authorized Official
Title or Position	:	INTERIM CHIEF FINANCIAL OFFICER
Name	:	MICHAEL RIEKER
Credential	:
Telephone Number	:	856-770-5729

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	05/03/2013

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Directions to “ROWANSOM DEPT OF PEDIATRICS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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