Healthcare Provider Details

I. General information

NPI: 1326985102
Provider Name (Legal Business Name): GRECIA ALTAGRACIA ROMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 W FARMS SQUARE PLZ APT 1N
BRONX NY
10460-2925
US

IV. Provider business mailing address

4 W FARMS SQUARE PLZ APT 1N
BRONX NY
10460-2925
US

V. Phone/Fax

Practice location:
  • Phone: 929-698-0240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number833655
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: