Healthcare Provider Details

I. General information

NPI: 1447299631
Provider Name (Legal Business Name): JUAN MANUEL ROMERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NORTHERN BLVD SUITE 216
GREAT NECK NY
11021-5200
US

IV. Provider business mailing address

600 NORTHERN BLVD SUITE 216
GREAT NECK NY
11021-5200
US

V. Phone/Fax

Practice location:
  • Phone: 516-466-0390
  • Fax: 516-466-4956
Mailing address:
  • Phone: 516-466-0390
  • Fax: 516-466-4956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number25MA07734500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME95436
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number231345
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: