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Organization
ROWANSOM NEW JERSEY INSTITUTE FOR SUCCESSFUL AGING
Active
Organization
ROWANSOM NEW JERSEY INSTITUTE FOR SUCCESSFUL AGING
Active
Other names
UMDNJ-SOM New Jersey Institute for Successful Aging
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, 1800, STRATFORD, NJ 08084
(856) 566-6843
(856) 566-6419
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
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
363L00000X
Nurse Practitioner
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3407004
—
NJ
01
—
CI0612
RAILROAD MEDICARE
NJ
Enumeration date
02/02/2006
Last updated
05/15/2013
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