Provider Demographics
NPI:1699712992
Name:ROMASH, RICHARD W (PT)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
Last Name:ROMASH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:W
Other - Last Name:ROMASH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 881
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-0569
Mailing Address - Country:US
Mailing Address - Phone:856-427-9311
Mailing Address - Fax:
Practice Address - Street 1:76 E EUCLID AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-2330
Practice Address - Country:US
Practice Address - Phone:856-427-9311
Practice Address - Fax:856-427-9310
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA000268400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0099513000OtherAMERIHEALTH INDIVIDUAL ID
NJ4479458OtherAETNA PPO PROVIDER #
NJ1116498OtherAETNA HMO PROVIDER
NJ2431302000OtherAMERIHEALTH HMO ID
NJ094982Medicare PIN
NJ4479458OtherAETNA PPO PROVIDER #
NJ425605UNNMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE