Healthcare Provider Details

I. General information

NPI: 1336221894
Provider Name (Legal Business Name): RICHARD ROMEO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 76TH ST
BROOKLYN NY
11228-2408
US

IV. Provider business mailing address

1450 76TH ST
BROOKLYN NY
11228-2408
US

V. Phone/Fax

Practice location:
  • Phone: 718-236-1176
  • Fax:
Mailing address:
  • Phone: 718-236-1176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberX007743
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: