Organization
ROWANSOM NMI HEADACHE
Active
Other names
UMDNJ-SOM University Headache Center
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 #1700, STRATFORD, NJ 08084-1354
(856) 566-7010
(856) 566-6956
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
—
6946208
—
NJ
01
—
CK0275
RAILROAD MEDICARE GROUP
NJ
Enumeration date
01/26/2006
Last updated
05/15/2013
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