Provider Demographics
NPI:1205957180
Name:SENIORMED CLINIC FOR AGING PA
Entity type:Organization
Organization Name:SENIORMED CLINIC FOR AGING PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROWEN
Authorized Official - Middle Name:GUMAPAS
Authorized Official - Last Name:DIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-736-8212
Mailing Address - Street 1:7 JANUSON CT
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3657
Mailing Address - Country:US
Mailing Address - Phone:973-736-8212
Mailing Address - Fax:973-736-0645
Practice Address - Street 1:7 JANUSON CT
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-3657
Practice Address - Country:US
Practice Address - Phone:973-736-8212
Practice Address - Fax:973-736-0645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 69300207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty