Provider Demographics
NPI:1861464968
Name:ROWANSOM NEWJERSEY INSTITUTE FOR SUCCESSFUL AGING-GERIATRIC NEUROLOGY
Entity Type:Organization
Organization Name:ROWANSOM NEWJERSEY INSTITUTE FOR SUCCESSFUL AGING-GERIATRIC NEUROLOGY
Other - Org Name:UMDNJ SOM NEWJERSEY INSTITUTE FOR SUCCESSFUL AGING-GERIATRIC NEUROLOGY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:INTERIM CHIEF FINANCIAL OFFICIER
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:PO BOX 635
Mailing Address - Street 2:
Mailing Address - City:BELLMAWR
Mailing Address - State:NJ
Mailing Address - Zip Code:08099-0635
Mailing Address - Country:US
Mailing Address - Phone:856-566-6706
Mailing Address - Fax:856-566-2797
Practice Address - Street 1:42 EAST LAUREL ROAD
Practice Address - Street 2:UDP, SUITE 1800
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084
Practice Address - Country:US
Practice Address - Phone:856-566-6843
Practice Address - Fax:856-566-6419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7850506Medicaid
NJCH6815OtherRAILROAD MEDICARE
NJCH6815OtherRAILROAD MEDICARE