Provider Demographics
NPI:1407210370
Name:ROWANSOM DEPT. OF PSYCHIATRY
Entity Type:Organization
Organization Name:ROWANSOM DEPT. OF PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position: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:856-566-6994
Mailing Address - Street 1:42 E LAUREL RD
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084-1354
Mailing Address - Country:US
Mailing Address - Phone:856-566-7020
Mailing Address - Fax:856-566-6188
Practice Address - Street 1:42 E LAUREL RD
Practice Address - Street 2:SUITE 2100
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1354
Practice Address - Country:US
Practice Address - Phone:856-566-7020
Practice Address - Fax:856-566-6188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0499056Medicaid