Provider Demographics
NPI:1376513309
Name:ROWANSOM DEPT OF PATHOLOGY
Entity Type:Organization
Organization Name:ROWANSOM DEPT OF PATHOLOGY
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 1:2201 CHAPEL AVE W
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-2048
Mailing Address - Country:US
Mailing Address - Phone:856-488-6560
Mailing Address - Fax:856-488-6846
Practice Address - Street 1:2201 CHAPEL AVE W
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2048
Practice Address - Country:US
Practice Address - Phone:856-488-6560
Practice Address - Fax:856-488-6846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3218503Medicaid
NJCD8996OtherRR MEDICARE
NJ0084836000OtherAMERIHEALTH
NJ154823Medicare ID - Type UnspecifiedGROUP