Provider Demographics
NPI:1487244414
Name:ROMERO, BRYAN PELAEZ (PA-C)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:PELAEZ
Last Name:ROMERO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 HALLS MILL RD
Mailing Address - Street 2:
Mailing Address - City:ASBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08802-1099
Mailing Address - Country:US
Mailing Address - Phone:732-832-6761
Mailing Address - Fax:
Practice Address - Street 1:1120 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2860
Practice Address - Country:US
Practice Address - Phone:732-200-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-23
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363A00000X
NJ25MP00644800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant