Provider Demographics
NPI:1629279211
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 1:712 E BAY AVE
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-3447
Mailing Address - Country:US
Mailing Address - Phone:609-978-7854
Mailing Address - Fax:609-978-7856
Practice Address - Street 1:712 E BAY AVE
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-3447
Practice Address - Country:US
Practice Address - Phone:609-978-7854
Practice Address - Fax:609-978-7856
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROTHMAN INSTITUTE OF NEW JERSEY, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-30
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4549550003Medicare NSC