1518937564 NPI number — ROWANSOM DEPT OF PULMONARY MEDICINE

Table of content: (NPI 1518937564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518937564 NPI number — ROWANSOM DEPT OF PULMONARY MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROWANSOM DEPT OF PULMONARY MEDICINE
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:
Provider Other Organization Name Type Code:
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:
1518937564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42 E LAUREL RD
Provider Second Line Business Mailing Address:
SUITE 3100
Provider Business Mailing Address City Name:
STRATFORD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08084-1354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-566-6859
Provider Business Mailing Address Fax Number:
856-566-6952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42 E LAUREL RD
Provider Second Line Business Practice Location Address:
SUITE 3100
Provider Business Practice Location Address City Name:
STRATFORD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08084-1354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-566-6859
Provider Business Practice Location Address Fax Number:
856-566-6952
Provider Enumeration Date:
01/24/2006

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 OFFICER
Authorized Official Telephone Number:
856-770-5729

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 033918 . This is a "MEDICARE ID" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: CD2384 . This is a "RR MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 33211 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2453475000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3152405 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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