# ROWANSOM VASCULAR LAB

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- **Entity:** Organization
- **Status:** Active
- **Other names:** UMDNJ-SOM Vascular Lab
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831160985
- **Authorized official:** MICHAEL RIEKER (INTERIM CHIEF FINANCIAL OFFICIER)
- **Authorized official phone:** (856) 770-5729

## Contact information

- **Practice address:** 42 E LAUREL RD, UDP, SUITE 2500, STRATFORD, NJ 08084-1354
- **Practice address phone:** (856) 566-2700
- **Practice address fax:** (856) 566-6873
- **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 |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/27/2006
- **Last updated:** 05/15/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 6502903 | — | NJ |
| 01 | — | CK5078 | RR MEDICARE | NJ |