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NPI Code Detail

MEDICARE: ROMTHERAPY CALIFORNIA MEDICAL PC

MEDICARE: ROMTHERAPY CALIFORNIA MEDICAL 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
1207RC0000XCardiovascular Disease Physician

General Provider Information

NPI Number : 1730944430
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROMTHERAPY CALIFORNIA MEDICAL PC
Provider Business Mailing Address
First Line : 101 SILVERMINE RD STE 300
Second Line :
City : BROOKFIELD
State : CT
Zip : 06804-2047
Country : US
Telephone Number : 888-374-0855
Fax Number :
Provider Business Practice Location Address
First Line : 2232 SIXTH ST.
Second Line :
City : BERKELEY
State : CA
Zip : 94710-2219
Country : US
Telephone Number : 888-374-0855
Fax Number :
Authorized Official
Title or Position : PRESIDENT/OWNER
Name : MR. GEORGE PETER STACY
Credential : M.D.
Telephone Number : 502-592-7743
Provider Enumeration Date : 02/21/2024
Last Update Date : 06/04/2026

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Directions to “ROMTHERAPY CALIFORNIA MEDICAL PC ” Practice Location

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