=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033364419
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUCRETIA S ROMERO MS-PAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2008
-----------------------------------------------------
Last Update Date | 06/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1217 N CHURCH ST
-----------------------------------------------------
City | MOORESTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08057-1143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-234-2828
-----------------------------------------------------
Fax | 856-235-8931
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 WINDERMERE DR
-----------------------------------------------------
City | LUMBERTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08048-5802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-518-6525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 25MP00211000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------