Healthcare Provider Details

I. General information

NPI: 1689851230
Provider Name (Legal Business Name): ROBERT M. ROMAINE, DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 ST AGNES HWY
COHOES NY
12047-3927
US

IV. Provider business mailing address

99 ST AGNES HWY
COHOES NY
12047-3927
US

V. Phone/Fax

Practice location:
  • Phone: 518-233-0669
  • Fax:
Mailing address:
  • Phone: 518-233-0669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN-002639-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License NumberN-002639-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberN002639-1
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberN002639-1
License Number StateNY

VIII. Authorized Official

Name: DR. ROBERT M. ROMAINE
Title or Position: OWNER
Credential: D.P.M.
Phone: 518-233-0669