MEDICARE: IVAN RENE ROMERO LSW

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	104100000X	Social Worker	44SL07037900	NJ

General Provider Information

NPI Number	:	1649044652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVAN RENE ROMERO LSW

Provider Business Mailing Address
First Line	:	6806 DURHAM AVE
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-3727
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6806 DURHAM AVE
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-3727
Country	:	US
Telephone Number	:	201-496-0463
Fax Number	:

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

Provider Enumeration Date	:	11/09/2023
Last Update Date	:	11/09/2023

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