1881668846 NPI number — ROWANSOM NEWJERSEY INSTITUTE FOR SUCCESSFUL AGING-GERIATRIC PSYCHIATRY

Table of content: (NPI 1881668846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881668846 NPI number — ROWANSOM NEWJERSEY INSTITUTE FOR SUCCESSFUL AGING-GERIATRIC PSYCHIATRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROWANSOM NEWJERSEY INSTITUTE FOR SUCCESSFUL AGING-GERIATRIC PSYCHIATRY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
UMDNJ-SOM NEWJERSEY INSTITUTE FORSUCCESSFUL AGING-GERIATRIC PSYCHIATRY
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881668846
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 635
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLMAWR
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08099-0635
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-566-6706
Provider Business Mailing Address Fax Number:
856-566-2797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42 EAST LAUREL ROAD
Provider Second Line Business Practice Location Address:
UDP, SUITE 1800
Provider Business Practice Location Address City Name:
STRATFORD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-566-6843
Provider Business Practice Location Address Fax Number:
856-566-6419
Provider Enumeration Date:
02/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RIEKER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
INTERIM CHIEF FINANCIAL OFFICIER
Authorized Official Telephone Number:
856-770-5729

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CK3636 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7851006 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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