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General NPI Number Information
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NPI Number | 1124355920
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Entity Type | Organization
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Legal Business Name | GARY ROMBOUGH MD PA
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Dates
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Enumeration Date | 11/16/2009
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Last Update Date | 11/16/2009
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Provider Practice Location Address
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Address Line | 141 CENTRAL AVE
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3003
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Country | US
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Telephone | 973-746-6844
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Fax | 973-746-4386
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Provider Business Mailing Address
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Address Line | 141 CENTRAL AVE
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City | MONTCLAIR
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State | NJ
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Zip | 07042-3003
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Country | US
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Telephone | 973-746-6844
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Fax | 973-746-4386
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY ROBERT ROMBOUGH
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Credential | M.D.
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Telephone | 973-746-6844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | 25MA03885700
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License Number State | NJ
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