# ROWANSOM NMI HEADACHE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** UMDNJ-SOM University Headache Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194796425
- **Authorized official:** MICHAEL RIEKER (INTERIM CHIEF FINANCIAL OFFICIER)
- **Authorized official phone:** (856) 770-5729

## Contact information

- **Practice address:** 42 E LAUREL RD, UDP \#1700, STRATFORD, NJ 08084-1354
- **Practice address phone:** (856) 566-7010
- **Practice address fax:** (856) 566-6956
- **Mailing address:** PO BOX 635, BELLMAWR, NJ 08099-0635
- **Mailing address phone:** (856) 566-6706
- **Mailing address fax:** (856) 566-2797

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/26/2006
- **Last updated:** 05/15/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 6946208 | — | NJ |
| 01 | — | CK0275 | RAILROAD MEDICARE GROUP | NJ |