Healthcare Provider Details

I. General information

NPI: 1457266751
Provider Name (Legal Business Name): WILNER ROMAIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 DUNHAM AVE
MOUNT VERNON NY
10553-2005
US

IV. Provider business mailing address

429 DUNHAM AVE
MOUNT VERNON NY
10553-2005
US

V. Phone/Fax

Practice location:
  • Phone: 347-842-7408
  • Fax:
Mailing address:
  • Phone: 347-842-7408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number357626
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: