Basic Information
| Provider Information | |||||||||
| NPI: | 1558563494 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROTHMAN INSTITUTE OF NEW JERSEY, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 ENGLISH CREEK AVE | ||||||||
| Address2: | BUILDING 1300 | ||||||||
| City: | EGG HARBOR TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082345549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096776060 | ||||||||
| FaxNumber: | 6096776061 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 ENGLISH CREEK AVE | ||||||||
| Address2: | BUILDING 1300 | ||||||||
| City: | EGG HARBOR TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082345549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6096776060 | ||||||||
| FaxNumber: | 6096776061 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2007 | ||||||||
| LastUpdateDate: | 04/10/2013 | ||||||||
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| AuthorizedOfficialLastName: | WEST | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2673393680 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ROTHMAN INSTITUTE OF NEW JERSEY, P.A. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 335E00000X | Y | Suppliers | Prosthetic/Orthotic Supplier |
No ID Information.