Healthcare Provider Details

I. General information

NPI: 1942018759
Provider Name (Legal Business Name): JESSICA TIL ROMERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 12/26/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GREATER BINGHAMTON HEALTH CENTER 425 ROBINSON ST
BINGHAMTON NY
13904-1735
US

IV. Provider business mailing address

314 RACHELLE AVE APT 1035
SANFORD FL
32771-7910
US

V. Phone/Fax

Practice location:
  • Phone: 607-724-1391
  • Fax:
Mailing address:
  • Phone: 386-414-0655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number506141
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: