Healthcare Provider Details

I. General information

NPI: 1871296525
Provider Name (Legal Business Name): ROMA JOHN APRN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2466 E CHESTNUT AVE STE 2
VINELAND NJ
08361-8486
US

IV. Provider business mailing address

90 MATAWAN RD STE 302
MATAWAN NJ
07747-2653
US

V. Phone/Fax

Practice location:
  • Phone: 856-691-2211
  • Fax: 856-839-4128
Mailing address:
  • Phone: 732-441-7177
  • Fax: 732-441-7165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ01460400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: