Healthcare Provider Details

I. General information

NPI: 1316102189
Provider Name (Legal Business Name): JANA ERIN ROMM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3424 KOSSUTH AVE
BRONX NY
10467-2410
US

IV. Provider business mailing address

3424 KOSSUTH AVE
BRONX NY
10467-2410
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-5437
  • Fax:
Mailing address:
  • Phone: 718-918-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number249615
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: