Provider Demographics
NPI:1255028502
Name:ROMAINE, LISA M
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:ROMAINE
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 1:38 SHERWOOD FOREST DR
Mailing Address - Street 2:
Mailing Address - City:BYRAM TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07821-4029
Mailing Address - Country:US
Mailing Address - Phone:973-216-7933
Mailing Address - Fax:
Practice Address - Street 1:95 E MAIN ST STE 115
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2158
Practice Address - Country:US
Practice Address - Phone:973-216-7933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist