Provider Demographics
NPI:1881987444
Name:NESIN, ROMY A (PHD)
Entity type:Individual
Prefix:DR
First Name:ROMY
Middle Name:A
Last Name:NESIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ROMY
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:361 IRVING AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2325
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28 MILLBURN AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1039
Practice Address - Country:US
Practice Address - Phone:917-418-3870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015164103TC0700X
NJ4885103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical