Provider Demographics
NPI:1366466773
Name:ROTHMAN INSTITUTE OF NEW JERSEY, P.A.
Entity Type:Organization
Organization Name:ROTHMAN INSTITUTE OF NEW JERSEY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-339-3500
Mailing Address - Street 1:443 LAUREL OAK RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4451
Mailing Address - Country:US
Mailing Address - Phone:856-821-6360
Mailing Address - Fax:856-821-6359
Practice Address - Street 1:443 LAUREL OAK RD
Practice Address - Street 2:SUITE 130
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4451
Practice Address - Country:US
Practice Address - Phone:856-821-6360
Practice Address - Fax:856-821-6359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ042928PFCMedicare ID - Type Unspecified