Basic Information
| Provider Information | |||||||||
| NPI: | 1538312624 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROTHMAN INSTITUTE OF NEW JERSEY, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 999 ROUTE 73 N | ||||||||
| Address2: | THIRD FLOOR | ||||||||
| City: | MARLTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080531227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568216360 | ||||||||
| FaxNumber: | 8568216359 | ||||||||
| Practice Location | |||||||||
| Address1: | 999 ROUTE 73 N | ||||||||
| Address2: | THIRD FLOOR | ||||||||
| City: | MARLTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080531227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568216360 | ||||||||
| FaxNumber: | 8568216359 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2008 | ||||||||
| LastUpdateDate: | 11/07/2012 | ||||||||
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| AuthorizedOfficialLastName: | WEST | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2673393680 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133VN1006X | Y | 193200000X MULTI-SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Metabolic |
No ID Information.