Healthcare Provider Details

I. General information

NPI: 1245158112
Provider Name (Legal Business Name): MOLLY TREOLE ROMAINE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 DIVISION ST
SOMERVILLE NJ
08876-2943
US

IV. Provider business mailing address

188 SPRING BEAUTY DR
LAWRENCE TOWNSHIP NJ
08648-1520
US

V. Phone/Fax

Practice location:
  • Phone: 201-688-3608
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: