Provider Demographics
NPI:1538312624
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:267-339-3680
Mailing Address - Street 1:999 ROUTE 73 N
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1227
Mailing Address - Country:US
Mailing Address - Phone:856-821-6360
Mailing Address - Fax:856-821-6359
Practice Address - Street 1:999 ROUTE 73 N
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1227
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:2008-11-03
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Multi-Specialty