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Organization
ROWANSOM DEPT OF FAMILY PRACTICE
Active
Organization
ROWANSOM DEPT OF FAMILY PRACTICE
Active
Other names
UMDNJ-SOM Dept of Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL RIEKER (INTERIM CHIEF FINANCIAL OFFICIER)
(856) 770-5729
Entity
Organization
Contact information
Practice address
42 EAST LAUREL ROAD, UDP, SUITE 2100, STRATFORD, NJ 08084
(856) 566-7020
(856) 566-6188
Mailing address
PO BOX 635, BELLMAWR, NJ 08099-0635
(856) 566-6706
(856) 566-2797
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3215709
—
NJ
01
—
CA1750
RR MEDICARE
NJ
Enumeration date
01/20/2006
Last updated
05/15/2013
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