Healthcare Provider Details

I. General information

NPI: 1598170417
Provider Name (Legal Business Name): STEM CELL AND REGENERATIVE MEDICINE INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 N BLACK HORSE PIKE
WILLIAMSTOWN NJ
08094-9120
US

IV. Provider business mailing address

2007 N BLACK HORSE PIKE
WILLIAMSTOWN NJ
08094-9120
US

V. Phone/Fax

Practice location:
  • Phone: 856-296-9616
  • Fax:
Mailing address:
  • Phone: 856-296-9616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number25MB07964500
License Number StateNJ

VIII. Authorized Official

Name: CHARLES NICHOLAS KROME
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 856-797-2879