Provider Demographics
NPI:1114181906
Name:EDWIN R ROMAN DPM LLC
Entity Type:Organization
Organization Name:EDWIN R ROMAN DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:908-352-1400
Mailing Address - Street 1:230 W JERSEY ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-1364
Mailing Address - Country:US
Mailing Address - Phone:908-352-1400
Mailing Address - Fax:908-352-7900
Practice Address - Street 1:230 W JERSEY ST
Practice Address - Street 2:SUITE 104
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-1364
Practice Address - Country:US
Practice Address - Phone:908-352-1400
Practice Address - Fax:908-352-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD002838213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty