Basic Information
Provider Information
NPI: 1689754152
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROMERO
FirstName: LUIS
MiddleName: N
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 436 CHRIS GAUPP DR
Address2: SUITE 204
City: GALLOWAY
State: NJ
PostalCode: 082059411
CountryCode: US
TelephoneNumber: 6096520100
FaxNumber: 6096520150
Practice Location
Address1: 436 CHRIS GAUPP DR
Address2: SUITE 204
City: GALLOWAY
State: NJ
PostalCode: 082054487
CountryCode: US
TelephoneNumber: 6096520100
FaxNumber: 6096520150
Other Information
ProviderEnumerationDate: 10/17/2006
LastUpdateDate: 11/04/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000X25MA03024000NJY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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