Healthcare Provider Details

I. General information

NPI: 1073864807
Provider Name (Legal Business Name): VICTORIA TERESA ROMANIELLO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 E MAIN ST
DENVILLE NJ
07834-2647
US

IV. Provider business mailing address

161 E MAIN ST
DENVILLE NJ
07834-2647
US

V. Phone/Fax

Practice location:
  • Phone: 973-627-7888
  • Fax: 973-627-7040
Mailing address:
  • Phone: 973-627-7888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01455200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: