1437248580 NPI number — DR. GLORIA MARCELO ROMEROCACES MD

Table of content: DR. GLORIA MARCELO ROMEROCACES MD (NPI 1437248580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437248580 NPI number — DR. GLORIA MARCELO ROMEROCACES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROMEROCACES
Provider First Name:
GLORIA
Provider Middle Name:
MARCELO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROMERO
Provider Other First Name:
GLORIA
Provider Other Middle Name:
MARCELO
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437248580
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 RIVER AVE BLDG 10
Provider Second Line Business Practice Location Address:
LAKEWOOD
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08701-5657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-901-7575
Provider Business Practice Location Address Fax Number:
732-901-1555
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  188666-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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