Provider Demographics
NPI:1700949039
Name:ROMAN, WILLIAM JOSEPH (PHD, PT)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:ROMAN
Suffix:
Gender:M
Credentials:PHD, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HOLMES ST
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1602
Mailing Address - Country:US
Mailing Address - Phone:908-797-2888
Mailing Address - Fax:973-379-7783
Practice Address - Street 1:12 HOLMES ST
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1602
Practice Address - Country:US
Practice Address - Phone:908-797-2888
Practice Address - Fax:973-379-7783
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA06268225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ077737Medicare PIN