MEDICARE: ALYSSA D ROMAN AGACNP

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	363LA2100X	Acute Care Nurse Practitioner	26NJ01246300	NJ

General Provider Information

NPI Number	:	1841959103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA D ROMAN AGACNP

Provider Business Mailing Address
First Line	:	1947 WHITE KNOLL DR
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08755-1734
Country	:	US
Telephone Number	:	732-616-8260
Fax Number	:

Provider Business Practice Location Address
First Line	:	1947 WHITE KNOLL DR
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08755-1734
Country	:	US
Telephone Number	:	732-616-8260
Fax Number	:

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

Provider Enumeration Date	:	12/14/2021
Last Update Date	:	12/14/2021

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