Provider Demographics
NPI: | 1497132484 |
---|---|
Name: | ROMEO A. TIU, M.D., P.A. |
Entity Type: | Organization |
Organization Name: | ROMEO A. TIU, M.D., P.A. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | ROMEO |
Authorized Official - Middle Name: | A |
Authorized Official - Last Name: | TIU |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 973-375-5500 |
Mailing Address - Street 1: | 40 UNION AVE STE 206 |
Mailing Address - Street 2: | |
Mailing Address - City: | IRVINGTON |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 07111-3290 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 973-375-5500 |
Mailing Address - Fax: | 973-996-2008 |
Practice Address - Street 1: | 40 UNION AVE STE 206 |
Practice Address - Street 2: | |
Practice Address - City: | IRVINGTON |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 07111-3290 |
Practice Address - Country: | US |
Practice Address - Phone: | 973-375-5500 |
Practice Address - Fax: | 973-996-2008 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-04-29 |
Last Update Date: | 2015-04-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NJ | 25MA02741500 | 261QH0100X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QH0100X | Ambulatory Health Care Facilities | Clinic/Center | Health Service |