MEDICARE: DR. GARY ROMAKA D.O.

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
1	207RN0300X	Nephrology Physician	25MB10556600	NJ

General Provider Information

NPI Number	:	1316280852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY ROMAKA D.O.

Provider Business Mailing Address
First Line	:	83 HANOVER RD SUITE 290
Second Line	:
City	:	FLORHAM PARK
State	:	NJ
Zip	:	07932-3332
Country	:	US
Telephone Number	:	973-736-2212
Fax Number	:

Provider Business Practice Location Address
First Line	:	83 HANOVER RD SUITE 290
Second Line	:
City	:	FLORHAM PARK
State	:	NJ
Zip	:	07932-3332
Country	:	US
Telephone Number	:	973-736-2212
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2013
Last Update Date	:	02/01/2021

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