Organization
ROWANSOM DEPT OF PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL RIEKER (INTERIM CHIEF FINANCIAL OFFICER)
(856) 770-5729
Entity
Organization
Contact information
Practice address
405 HURFFVILLE CROSSKEYS RD, SUITE 203, SEWELL, NJ 08080-9340
(856) 582-0033
(856) 582-2305
Mailing address
405 HURFFVILLE CROSSKEYS RD, SUITE 203, SEWELL, NJ 08080-9340
(856) 582-0033
(856) 582-2305
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0433159006
AMERIHEALTH
NJ
01
—
2110070
AETNA
NJ
05
—
3156907
—
NJ
Enumeration date
01/24/2006
Last updated
05/03/2013
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