Healthcare Provider Details

I. General information

NPI: 1538161484
Provider Name (Legal Business Name): CONSTANCE ANNE ROMANO D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 GRAHAM AVE
BROOKLYN NY
11211-2424
US

IV. Provider business mailing address

136 EUCLID AVE
ARDSLEY NY
10502-2503
US

V. Phone/Fax

Practice location:
  • Phone: 718-389-9870
  • Fax: 718-383-0525
Mailing address:
  • Phone: 914-674-1109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN004427
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: