=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609214584
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA ROMANO FPMHNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2013
-----------------------------------------------------
Last Update Date | 08/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 HORIZON CENTER BLVD STE 117
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08691-1910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 848-244-1650
-----------------------------------------------------
Fax | 732-377-7773
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 34 GLENWOOD TER
-----------------------------------------------------
City | FORDS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08863-1339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-939-4169
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 26NJ00440600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------