Provider Demographics
NPI:1467422287
Name:ROWANSOM DEPT OF RHEUMATOLOGY
Entity Type:Organization
Organization Name:ROWANSOM DEPT OF RHEUMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:KELIYVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-566-6831
Mailing Address - Street 1:PO BOX 71356
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19176-1356
Mailing Address - Country:US
Mailing Address - Phone:856-582-5678
Mailing Address - Fax:856-582-8868
Practice Address - Street 1:42 E LAUREL RD STE 3100
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1354
Practice Address - Country:US
Practice Address - Phone:856-566-7070
Practice Address - Fax:856-566-5079
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROWAN UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ34409OtherAETNA
NJCG7649OtherRR MEDICARE
NJ3152103Medicaid
NJ0072921000OtherAMERIHEALTH
NJ0072921000OtherAMERIHEALTH