Provider Demographics
NPI:1033364419
Name:ROMERO, LUCRETIA S (MS-PAC)
Entity Type:Individual
Prefix:
First Name:LUCRETIA
Middle Name:S
Last Name:ROMERO
Suffix:
Gender:F
Credentials:MS-PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 WINDERMERE DR
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08048-5802
Mailing Address - Country:US
Mailing Address - Phone:609-518-6525
Mailing Address - Fax:
Practice Address - Street 1:1217 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-1143
Practice Address - Country:US
Practice Address - Phone:856-234-2828
Practice Address - Fax:856-235-8931
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00211000363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical