Healthcare Provider Details

I. General information

NPI: 1164715934
Provider Name (Legal Business Name): NOE DURAN ROMO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S
BRONX NY
10461-1138
US

IV. Provider business mailing address

312 W 119TH ST APT 4M
NEW YORK NY
10026-1066
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-6977
  • Fax:
Mailing address:
  • Phone: 951-675-6335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number261112
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: