Healthcare Provider Details

I. General information

NPI: 1942664768
Provider Name (Legal Business Name): ROMERO ONCOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 AVIS DR SUITE 101
LATHAM NY
12110-2650
US

IV. Provider business mailing address

4 AVIS DR SUITE 101
LATHAM NY
12110-2650
US

V. Phone/Fax

Practice location:
  • Phone: 518-656-4444
  • Fax: 518-656-4444
Mailing address:
  • Phone: 518-656-4444
  • Fax: 518-656-4444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number210422
License Number StateNY

VIII. Authorized Official

Name: MARIA AYALA
Title or Position: BILLING MANAGER
Credential:
Phone: 917-709-8590