Provider Demographics
NPI:1699078485
Name:ROMBACH, EMMAJEAN (LAC)
Entity type:Individual
Prefix:
First Name:EMMAJEAN
Middle Name:
Last Name:ROMBACH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:WEST STOCKBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01266-0264
Mailing Address - Country:US
Mailing Address - Phone:518-223-3717
Mailing Address - Fax:
Practice Address - Street 1:68 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:01240-2399
Practice Address - Country:US
Practice Address - Phone:413-551-9199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-16
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4429171100000X
MA250689171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist