Provider Demographics
NPI:1306086566
Name:ROMAN, JOLANTA E (RD)
Entity type:Individual
Prefix:MRS
First Name:JOLANTA
Middle Name:E
Last Name:ROMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8840 STENTON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-2846
Mailing Address - Country:US
Mailing Address - Phone:267-254-9700
Mailing Address - Fax:215-242-2680
Practice Address - Street 1:832 GERMANTOWN PIKE
Practice Address - Street 2:SUIT 3
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-2442
Practice Address - Country:US
Practice Address - Phone:267-254-9700
Practice Address - Fax:215-242-2680
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA727625133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic