Provider Demographics
NPI:1093762023
Name:ROMALINO, ROBERT JOSEPH (MPT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:ROMALINO
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 N BLACK HORSE PIKE
Mailing Address - Street 2:SUITE #5
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-1483
Mailing Address - Country:US
Mailing Address - Phone:856-728-4100
Mailing Address - Fax:856-728-4415
Practice Address - Street 1:1035 N BLACK HORSE PIKE
Practice Address - Street 2:SUITE #5
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-1483
Practice Address - Country:US
Practice Address - Phone:856-728-4100
Practice Address - Fax:856-728-4415
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00962300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ051476Medicare PIN