Basic Information
| Provider Information | |||||||||
| NPI: | 1467422287 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROWANSOM DEPT OF RHEUMATOLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 71356 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191761356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8565825678 | ||||||||
| FaxNumber: | 8565828868 | ||||||||
| 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: | 01/24/2006 | ||||||||
| LastUpdateDate: | 06/24/2019 | ||||||||
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| AuthorizedOfficialLastName: | WORKMAN | ||||||||
| AuthorizedOfficialFirstName: | KELIYVETTE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF MANAGED CARE | ||||||||
| AuthorizedOfficialTelephone: | 8565666831 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ROWAN UNIVERSITY | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.