Healthcare Provider Details

I. General information

NPI: 1235125113
Provider Name (Legal Business Name): MADELINE L. ROMEU O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 11/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6408 BERGENLINE AVE
WEST NEW YORK NJ
07093-1660
US

IV. Provider business mailing address

6408 BERGENLINE AVE
WEST NEW YORK NJ
07093-1660
US

V. Phone/Fax

Practice location:
  • Phone: 201-868-3603
  • Fax: 201-868-4074
Mailing address:
  • Phone: 201-868-3603
  • Fax: 201-868-4074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00365600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: