Healthcare Provider Details

I. General information

NPI: 1881913622
Provider Name (Legal Business Name): ROMAN ISAAC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 ADAMS ST STE DE
HOBOKEN NJ
07030-2370
US

IV. Provider business mailing address

1320 ADAMS ST STE DE
HOBOKEN NJ
07030-2370
US

V. Phone/Fax

Practice location:
  • Phone: 201-241-2044
  • Fax:
Mailing address:
  • Phone: 201-308-6622
  • Fax: 201-308-6623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number275010
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MA09692400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: