Provider Demographics
NPI:1790987220
Name:ROMAIN, SHARON
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:
Last Name:ROMAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 HAMBURG TPKE
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07457-1160
Mailing Address - Country:US
Mailing Address - Phone:973-835-7290
Mailing Address - Fax:973-835-0696
Practice Address - Street 1:72 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-1160
Practice Address - Country:US
Practice Address - Phone:973-835-7290
Practice Address - Fax:973-835-0696
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08257600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ112986WC0Medicare PIN