Healthcare Provider Details

I. General information

NPI: 1013897669
Provider Name (Legal Business Name): MEDICAL WELLNESS PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ROUTE 31 N
PENNINGTON NJ
08534-1606
US

IV. Provider business mailing address

10 ROUTE 31 N
PENNINGTON NJ
08534-1606
US

V. Phone/Fax

Practice location:
  • Phone: 609-570-6980
  • Fax: 877-732-7317
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN J ROMAN JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 609-578-6980