MEDICARE: MS. LISA VERA ROMANACCE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	F420642	NY

General Provider Information

NPI Number	:	1861402976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA VERA ROMANACCE NP

Provider Business Mailing Address
First Line	:	2171 JERICHO TPKE
Second Line	:
City	:	COMMACK
State	:	NY
Zip	:	11725-2937
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2171 JERICHO TPKE
Second Line	:
City	:	COMMACK
State	:	NY
Zip	:	11725-2937
Country	:	US
Telephone Number	:	631-854-1016
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	04/19/2023

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