Provider Demographics
NPI:1376785881
Name:ROMAN, JACQUELINE D (DO)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:D
Last Name:ROMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 HIGHWAY 35 # II
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-3537
Mailing Address - Country:US
Mailing Address - Phone:973-432-7640
Mailing Address - Fax:732-517-1359
Practice Address - Street 1:1300 HIGHWAY 35 # II
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-3537
Practice Address - Country:US
Practice Address - Phone:973-432-7640
Practice Address - Fax:732-517-1359
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09178100207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology