Provider Demographics
NPI:1174290035
Name:ROMERO MOLINA, SCARLETH JOHANA (PTA)
Entity Type:Individual
Prefix:
First Name:SCARLETH
Middle Name:JOHANA
Last Name:ROMERO MOLINA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 32ND ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-5874
Mailing Address - Country:US
Mailing Address - Phone:201-268-9745
Mailing Address - Fax:
Practice Address - Street 1:2014 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-3313
Practice Address - Country:US
Practice Address - Phone:201-348-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225200000X
NJ40QB00387900225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant