Healthcare Provider Details

I. General information

NPI: 1609391135
Provider Name (Legal Business Name): PHILLIP E ROMERO MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E 57TH ST STE 640
NEW YORK NY
10022-2392
US

IV. Provider business mailing address

115 E 57TH ST STE 640
NEW YORK NY
10022-2392
US

V. Phone/Fax

Practice location:
  • Phone: 212-477-9886
  • Fax: 646-612-7947
Mailing address:
  • Phone: 212-477-9886
  • Fax: 646-612-7947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number130742
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number130742
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number130742
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number130742
License Number StateNY

VIII. Authorized Official

Name: PHILLIP EARL ROMERO
Title or Position: PRESIDENT
Credential: MD
Phone: 212-477-9886