1518937564 NPI number — ROWANSOM DEPT OF PULMONARY MEDICINE

Table of Contents

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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