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NPI Code Detail

MEDICARE: ROMAN GONT DC PC

MEDICARE: ROMAN GONT DC PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor38MC00573700NJ

General Provider Information

NPI Number : 1063600690
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROMAN GONT DC PC
Provider Business Mailing Address
First Line : 13-51 RIVER RD
Second Line : SUITE B
City : FAIR LAWN
State : NJ
Zip : 07410-1837
Country : US
Telephone Number : 201-398-0020
Fax Number : 201-398-0029
Provider Business Practice Location Address
First Line : 13-51 RIVER RD
Second Line : SUITE B
City : FAIR LAWN
State : NJ
Zip : 07410-1837
Country : US
Telephone Number : 201-398-0020
Fax Number : 201-398-0029
Authorized Official
Title or Position : CHIROPRACTOR
Name : DR. ROMAN GONT
Credential : DC
Telephone Number : 201-398-0020
Provider Enumeration Date : 10/09/2007
Last Update Date : 10/09/2007

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