Healthcare Provider Details

I. General information

NPI: 1508760646
Provider Name (Legal Business Name): CARLY ANUSTA ROMEUS APN-PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 US HIGHWAY 22
MOUNTAINSIDE NJ
07092-2807
US

IV. Provider business mailing address

1199 US HIGHWAY 22
MOUNTAINSIDE NJ
07092-2807
US

V. Phone/Fax

Practice location:
  • Phone: 908-500-3387
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ15641100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: