Basic Information
| Provider Information | |||||||||
| NPI: | 1932612660 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROTHMAN INSTITUTE OF NEW JERSEY, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 833 CHESTNUT ST STE 1402 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074404 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 106 SOUTH DENNIS ROAD | ||||||||
| Address2: | BUILDING 200, SUITE 200 | ||||||||
| City: | CAPE MAY COURT HOUSE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2673393500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2017 | ||||||||
| LastUpdateDate: | 11/16/2017 | ||||||||
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| AuthorizedOfficialLastName: | PINO | ||||||||
| AuthorizedOfficialFirstName: | GINA | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS OFFICE LOCATION | ||||||||
| AuthorizedOfficialTelephone: | 2673393500 | ||||||||
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| 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.