Healthcare Provider Details

I. General information

NPI: 1316903313
Provider Name (Legal Business Name): NICHOLAS ALEXANDER ROMANOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 11/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 E ROUTE #70
CHERRY HILL NJ
08034
US

IV. Provider business mailing address

1034 E RT70
CHERRY HILL NJ
08034
US

V. Phone/Fax

Practice location:
  • Phone: 856-429-4922
  • Fax: 856-429-7780
Mailing address:
  • Phone: 856-429-4922
  • Fax: 856-429-7780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberMA25049
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: