Provider Demographics
NPI:1992730253
Name:MADISON MEDICAL AND SPORTS REHABILITATION L.L.C
Entity type:Organization
Organization Name:MADISON MEDICAL AND SPORTS REHABILITATION L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:973-377-6700
Mailing Address - Street 1:210 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-2209
Mailing Address - Country:US
Mailing Address - Phone:973-377-6700
Mailing Address - Fax:973-377-8008
Practice Address - Street 1:210 MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-2209
Practice Address - Country:US
Practice Address - Phone:973-377-6700
Practice Address - Fax:973-377-8008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00562600111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========DOtherBC/BS
NJU83514Medicare UPIN
NJ045095R76Medicare ID - Type Unspecified