Basic Information
| Provider Information | |||||||||
| NPI: | 1669428413 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROMAINE | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 161 MILLBURN AVE | ||||||||
| Address2: | MCRC PHYSICAL THERAPY | ||||||||
| City: | MILLBURN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070411825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9733767100 | ||||||||
| FaxNumber: | 9733767101 | ||||||||
| Practice Location | |||||||||
| Address1: | 42 FAIRFIELD PL | ||||||||
| Address2: | |||||||||
| City: | WEST CALDWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070066212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732278585 | ||||||||
| FaxNumber: | 9732278575 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40 QA01098800 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.