Basic Information
Provider Information | |||||||||
NPI: | 1306009709 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | COLEMAN | ||||||||
FirstName: | ASHLEY | ||||||||
MiddleName: | J | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ROWAN | ||||||||
OtherFirstName: | ASHLEY | ||||||||
OtherMiddleName: | J | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | D.O. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 42 E LAUREL RD STE 3100 | ||||||||
Address2: |   | ||||||||
City: | STRATFORD | ||||||||
State: | NJ | ||||||||
PostalCode: | 080841354 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8565667070 | ||||||||
FaxNumber: | 8565665079 | ||||||||
Practice Location | |||||||||
Address1: | 42 E LAUREL RD STE 3100 | ||||||||
Address2: |   | ||||||||
City: | STRATFORD | ||||||||
State: | NJ | ||||||||
PostalCode: | 080841354 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8565667070 | ||||||||
FaxNumber: | 8565665079 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/07/2008 | ||||||||
LastUpdateDate: | 06/17/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/17/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0T011535 | PA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208M00000X | 25MB08662200 | NJ | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   | 207R00000X | 25MB08662200 | NJ | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.