MEDICARE: DR. GLORIA MARCELO ROMEROCACES MD

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	188666-1	NY

General Provider Information

NPI Number	:	1437248580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLORIA MARCELO ROMEROCACES MD

Provider Business Mailing Address
First Line	:	1 ADRIAN WAY
Second Line	:
City	:	RIVER EDGE
State	:	NJ
Zip	:	07661-1452
Country	:	US
Telephone Number	:	201-262-1867
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 RIVER AVE BLDG 10
Second Line	:	LAKEWOOD
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5657
Country	:	US
Telephone Number	:	732-901-7575
Fax Number	:	732-901-1555

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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