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General NPI Number Information
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NPI Number | 1376785881
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Entity Type | Individual
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Provider Name | JACQUELINE D ROMAN D.O.
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Gender | Female
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Dates
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Enumeration Date | 03/30/2009
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Last Update Date | 08/21/2013
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Provider Practice Location Address
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Address Line | 1300 HIGHWAY 35 # II
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City | OCEAN
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State | NJ
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Zip | 07712-3537
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Country | US
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Telephone | 973-432-7640
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Fax | 732-517-1359
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Provider Business Mailing Address
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Address Line | 1300 HIGHWAY 35 # II
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City | OCEAN
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State | NJ
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Zip | 07712-3537
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Country | US
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Telephone | 973-432-7640
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Fax | 732-517-1359
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 25MB09178100
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License Number State | NJ
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