Healthcare Provider Details

I. General information

NPI: 1932479318
Provider Name (Legal Business Name): ROGER ROMANCHIK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 MAIN ST
HELLERTOWN PA
18055-1320
US

IV. Provider business mailing address

1225 MAIN ST
HELLERTOWN PA
18055-1320
US

V. Phone/Fax

Practice location:
  • Phone: 610-838-7220
  • Fax:
Mailing address:
  • Phone: 610-838-7220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number83307368
License Number StatePA

VIII. Authorized Official

Name: ROGER J ROMANCHIK
Title or Position: OWNER
Credential: OPT
Phone: 610-838-7220