Provider Demographics
NPI:1063600690
Name:ROMAN GONT DC PC
Entity type:Organization
Organization Name:ROMAN GONT DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GONT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-398-0020
Mailing Address - Street 1:13-51 RIVER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1837
Mailing Address - Country:US
Mailing Address - Phone:201-398-0020
Mailing Address - Fax:201-398-0029
Practice Address - Street 1:13-51 RIVER RD
Practice Address - Street 2:SUITE B
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1837
Practice Address - Country:US
Practice Address - Phone:201-398-0020
Practice Address - Fax:201-398-0029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00573700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ075551Medicare PIN