Provider Demographics
NPI:1619085461
Name:ROMANO, PASQUALE ALOYSIUS (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:PASQUALE
Middle Name:ALOYSIUS
Last Name:ROMANO
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:PAT
Other - Middle Name:
Other - Last Name:ROMANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OPTICIAN
Mailing Address - Street 1:41 EAST KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:NJ
Mailing Address - Zip Code:08106-1216
Mailing Address - Country:US
Mailing Address - Phone:856-547-3188
Mailing Address - Fax:
Practice Address - Street 1:41 EAST KINGS HWY
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:NJ
Practice Address - Zip Code:08106-1216
Practice Address - Country:US
Practice Address - Phone:856-547-3188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00095600332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0272720001Medicare ID - Type Unspecified