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Organization
ROWANSOM VASCULAR LAB
Active
Organization
ROWANSOM VASCULAR LAB
Active
Other names
UMDNJ-SOM Vascular Lab
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 E LAUREL RD, UDP, SUITE 2500, STRATFORD, NJ 08084-1354
(856) 566-2700
(856) 566-6873
Mailing address
PO BOX 635, BELLMAWR, NJ 08099-0635
(856) 566-6706
(856) 566-2797
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
NULL
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6502903
—
NJ
01
—
CK5078
RR MEDICARE
NJ
Enumeration date
01/27/2006
Last updated
05/15/2013
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