Healthcare Provider Details

I. General information

NPI: 1073432688
Provider Name (Legal Business Name): RENIELYZ ROMERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 READE PL
POUGHKEEPSIE NY
12601-3947
US

IV. Provider business mailing address

7 RAMBLEWOOD DR
NEWBURGH NY
12550-8782
US

V. Phone/Fax

Practice location:
  • Phone: 845-454-8500
  • Fax:
Mailing address:
  • Phone: 329-209-2613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1234
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: