Healthcare Provider Details

I. General information

NPI: 1922934116
Provider Name (Legal Business Name): NICHOLAS ROMANO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 GRANT ST
BRIDGEPORT CT
06610-2870
US

IV. Provider business mailing address

296 CLEARVIEW AVE
HARWINTON CT
06791-1105
US

V. Phone/Fax

Practice location:
  • Phone: 203-384-3388
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number23.007772
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: