Provider Demographics
NPI:1003896341
Name:ROWANSOM DEPT OF MATERNAL-FETAL MEDICINE
Entity Type:Organization
Organization Name:ROWANSOM DEPT OF MATERNAL-FETAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIEKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-770-5729
Mailing Address - Street 1:570 EGG HARBOR RD
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-2359
Mailing Address - Country:US
Mailing Address - Phone:856-218-0300
Mailing Address - Fax:856-589-9487
Practice Address - Street 1:570 EGG HARBOR RD
Practice Address - Street 2:SUITE C-2
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2359
Practice Address - Country:US
Practice Address - Phone:856-218-0300
Practice Address - Fax:856-589-9487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6304401Medicaid
NJ0739469000OtherAMERIHEALTH
NJ478591OtherAETNA
NJDQ4958OtherRR MEDICARE
NJ478591OtherAETNA
NJ544420Medicare ID - Type UnspecifiedGROUP