Provider Demographics
NPI:1124355920
Name:GARY ROMBOUGH MD PA
Entity Type:Organization
Organization Name:GARY ROMBOUGH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ROMBOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-746-6844
Mailing Address - Street 1:141 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3003
Mailing Address - Country:US
Mailing Address - Phone:973-746-6844
Mailing Address - Fax:973-746-4386
Practice Address - Street 1:141 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3003
Practice Address - Country:US
Practice Address - Phone:973-746-6844
Practice Address - Fax:973-746-4386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03885700207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C56283Medicare UPIN