Healthcare Provider Details

I. General information

NPI: 1992730253
Provider Name (Legal Business Name): MADISON MEDICAL AND SPORTS REHABILITATION L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 MAIN ST
MADISON NJ
07940-2209
US

IV. Provider business mailing address

210 MAIN ST
MADISON NJ
07940-2209
US

V. Phone/Fax

Practice location:
  • Phone: 973-377-6700
  • Fax: 973-377-8008
Mailing address:
  • Phone: 973-377-6700
  • Fax: 973-377-8008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number38MC00562600
License Number StateNJ

VIII. Authorized Official

Name: DR. CARMEN ROMANO
Title or Position: OWNER
Credential: DC
Phone: 973-377-6700