=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679856074
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROMAN MARKH PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2011
-----------------------------------------------------
Last Update Date | 04/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 CLARA MAASS DR
-----------------------------------------------------
City | BELLEVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07109-3550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-450-2000
-----------------------------------------------------
Fax | 732-923-2272
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 379 CAMPUS DR FL 4
-----------------------------------------------------
City | SOMERSET
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08873-1161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-937-8939
-----------------------------------------------------
Fax | 732-418-8372
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number | 25MP00393800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 25MP00393800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------