MEDICARE: ROWANSOM DEPT OF PSYCHIATRY

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	CA8142	OTHER	NJ	RR MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1044766	OTHER	NJ	CIGNA GRP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0099409000	OTHER	NJ	AMERIHEALTH GRP
4	8421390	OTHER	NJ	AETNA GRP

NPI Number	:	1689644122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROWANSOM DEPT OF PSYCHIATRY

Provider Business Mailing Address
First Line	:	2250 CHAPEL AVE W
Second Line	:	SUITE 100
City	:	CHERRY HILL
State	:	NJ
Zip	:	08002-2051
Country	:	US
Telephone Number	:	856-482-9000
Fax Number	:	856-482-1159

Provider Business Practice Location Address
First Line	:	2250 CHAPEL AVE W
Second Line	:	SUITE 100
City	:	CHERRY HILL
State	:	NJ
Zip	:	08002-2051
Country	:	US
Telephone Number	:	856-482-9000
Fax Number	:	856-482-1159

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	03/21/2016

2250 CHAPEL AVE W STE 130
CHERRY HILL, NJ
08002-2051

Practice Phone: 856-663-3733
Practice Fax: 856-663-3660

2250 CHAPEL AVE W , SUITE 100
CHERRY HILL, NJ
08002-2051