Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | PTA.0015097 | CO |
NPI | 1053075275 |
---|---|
Provider Name | Jacob Romanuski |
First Address | Pittston, PA 18640-1320 |
Second Address | Denver, CO 80221-7600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2021 |
Last Update Date | 25/10/2021 |