Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | 31TD00351400 | NJ |
NPI | 1780973834 |
---|---|
Provider Name | Mr. Roger R Romero SR. |
First Address | Union City, NJ 07087-2468 |
Second Address | Union City, NJ 07087-2468 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2011 |
Last Update Date | 29/03/2011 |