Organization
ROWANSOM NEWJERSEY INSTITUTE FOR SUCCESSFUL AGING-GERIATRIC PSYCHIATRY
Active
Other names
UMDNJ-SOM NewJersey Institute forSuccessful Aging-Geriatric Psychiatry
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, SUITE 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
103G00000X
Clinical Neuropsychologist
—
—
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7851006
—
NJ
01
—
CK3636
RAILROAD MEDICARE
NJ
Enumeration date
02/15/2006
Last updated
05/15/2013
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