Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | MB062999 | NJ |
NPI | 1124148333 |
---|---|
Provider Name | Dr. Charles Joseph Roman SR. |
First Address | Somers Point, NJ 08244-1019 |
Second Address | North Cape May, NJ 08204-3208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G25126 | (02) | PA |