Provider Demographics
NPI:1427136993
Name:ROMANCZUK, BRUCE J (MD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:J
Last Name:ROMANCZUK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 BEACON AVENUE
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2626
Mailing Address - Country:US
Mailing Address - Phone:609-597-7110
Mailing Address - Fax:609-597-7113
Practice Address - Street 1:1145 BEACON AVENUE
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-2626
Practice Address - Country:US
Practice Address - Phone:609-597-7110
Practice Address - Fax:609-597-7113
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03704500207Y00000X
PAMD017065E207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0185580000OtherAMERIHEALTH
0600528OtherGHI
4100689OtherAETNA
82567570OtherLOCAL
82567570OtherLOCAL
NJ0185580000OtherAMERIHEALTH